title: Magnetic resonance enterography: safe and effective imaging for stricturing Crohn's disease.
abstract: BACKGROUND
  Symptomatic Crohn's disease (CD) patients often undergo diagnostic imaging studies for evaluation of disease activity or complications including bowel strictures and obstruction. Magnetic resonance enterography (MRE) provides information regarding disease activity, chronicity, and stricture formation without using ionizing radiation.
  
  
  OBJECTIVE
  Examine the use of MRE among CD patients presenting with symptoms suggesting obstruction in a tertiary care practice setting.
  
  
  METHODS
  We performed a retrospective study of all CD patients undergoing MRE at a tertiary IBD referral center over a 3-year study period including a subgroup analysis of patients presenting obstructive symptoms. Positive and negative findings from MRE were correlated with medical and surgical decision outcomes over the subsequent 90-day period.
  
  
  RESULTS
  In the study, 119 CD patients underwent 133 MRE scans, including 40 scans on individuals presenting with obstructive symptoms. Positive findings of CD including active inflammation, stricturing, and penetrating disease were more frequent in MREs ordered to evaluate obstructive symptoms (87.5%) compared other indications (58.1%, p = 0.001). In patients presenting with obstructive symptoms, MRE findings assisted in directing a change of clinical management towards escalation of medical therapy in 55% and surgery in 32.5%. Review of surgical resection specimens corroborated MRE findings of disease activity and fibrosis in 92% of cases going to surgery.
  
  
  CONCLUSIONS
  In practice-based use at a tertiary IBD referral center, MRE provided an effective, radiation-free alternative to computed tomography by providing valuable diagnostic information for evaluating and directing care in Crohn's disease, particularly for patients presenting with obstructive symptoms.
authors.affiliation: Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA. christina.ha@jhmi.edu
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Ha
authors.forename: Nitin
authors.initials: N
authors.lastname: Kumar
authors.forename: Constantine A
authors.initials: CA
authors.lastname: Raptis
authors.forename: Vamsi R
authors.initials: VR
authors.lastname: Narra
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Ciorba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult