title: 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?
abstract: 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.
authors.affiliation: Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. christiane.girlich@klinik.uni-regensburg.de
authors.forename: Christiane
authors.initials: C
authors.lastname: Girlich
authors.forename: Claudia
authors.initials: C
authors.lastname: Ott
authors.forename: Ulrike
authors.initials: U
authors.lastname: Strauch
authors.forename: Doris
authors.initials: D
authors.lastname: Schacherer
authors.forename: Florian
authors.initials: F
authors.lastname: Obermeier
authors.forename: Ernst Michael
authors.initials: EM
authors.lastname: Jung
authors.forename: Jürgen
authors.initials: J
authors.lastname: Schölmerich
authors.forename: Andreas Georg
authors.initials: AG
authors.lastname: Schreyer
authors.forename: Frank
authors.initials: F
authors.lastname: Klebl
mesh_terms: 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
chemical_list: D002097:C-Reactive Protein