Clinical feature and bowel ultrasound in Crohn's disease - does additional information from magnetic resonance imaging affect therapeutic approach and when does extended diagnostic investigation make sense?
OBJECTIVE
Some suggest MRI to be superior to ultrasound in Crohn's disease. We analyzed how often MR enterography (MRE) following a routine ultrasound leads to a change in therapeutic decision.


METHODS
We retrospectively evaluated 47 patients with Crohn's disease undergoing routine ultrasound examination. Actual medical history, complete blood count, C-reactive protein (CRP), and sonographic findings were assessed independently by two specialists who retrospectively provided a therapeutic proposal. Additionally, all patients received MRE. Thereafter, the specialists had to provide a new therapeutic concept regarding all the available information.


RESULTS
Evaluation of the rectum was not successful by ultrasound, but MRE gave good results. Only 1 of 7 abscesses was identified sonographically. Three of the abscesses missed at sonography were localized in the perirectal/perianal region. MRE detected more inflamed bowel segments, but ultrasound assessment of anatomically fixed bowel parts showed good recognition by MRE. With increasing CRP values, we found more positive results of ultrasound and MRE. Therapeutic change was suggested in only 18 patients.


CONCLUSIONS
Ultrasound should be performed by an experienced examiner, and a proctological examination should be added. MRE is justified in cases of discrepancy between clinical findings and the results of diagnostic ultrasound and, moreover, if Crohn's lesions are suspected at sites proximal to the terminal or neoterminal ileum.
Girlich
Christiane
C
Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. christiane.girlich@klinik.uni-regensburg.de
Ott
Claudia
C
Strauch
Ulrike
U
Schacherer
Doris
D
Obermeier
Florian
F
Jung
Ernst Michael
EM
Schölmerich
Jürgen
J
Schreyer
Andreas Georg
AG
Klebl
Frank
F
D000038:Abscess / Q000000981:diagnostic imaging*; D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology; D007583:Jejunum / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D012007:Rectum / Q000000981:diagnostic imaging / Q000473:pathology; D012189:Retrospective Studies; D014463:Ultrasonography; D055815:Young Adult
D002097:C-Reactive Protein