title: Diagnostic and therapeutic impact of MR enterography in Crohn's disease.
abstract: OBJECTIVE
  To assess the impact of magnetic resonance enterography (MRE) on clinician diagnostic confidence and therapeutic strategy in patients under investigation for small bowel Crohn's disease.
  
  
  METHODS
  Gastroenterologists completed a proforma before and following MRE in 51 patients (mean age 35 years, 26 female) under investigation for small bowel Crohn's disease, indicating percentage confidence for presence/absence of small bowel involvement. In suspected disease, diagnostic confidence (using a scoring system from 1=no to 6=yes) was scored for subcategories: extent >30 cm (DE), terminal ileum (lTI), jejunal (JD), colonic disease (CoD), strictures (ST), activity (AD), extraluminal complications (EL), and surgical need (NS). Therapeutic strategy was recorded. Patients were divided into three groups: 1=suspected disease, MRE normal (n=15); 2=suspected disease, MRE abnormal (n=30); 3=no suspected disease, MRE normal (n=6). Binomial exact and paired t-tests were use to compare confidence pre and post-MRE.
  
  
  RESULTS
  Mean percentage confidence for the presence/absence of small bowel disease increased from 62 to 84% (p=0.003), 87 to 98% (p=0.0001), and 83 to 98% (p=0.005) after MRE for groups 1, 2, and 3, respectively. In suspected disease, confidence changed significantly for all of the subcategories (p<0.001) except EL in group 1. The percentage of patients with a confidence change ranged from 40% (CoD) to 87% (lTI; group 1) and from 7% (EL) to 93% (DE; group 2). Therapeutic strategy changed in 31/51 (61%, 95% CI 47-74%), 14 with a reduction in planned therapy and 17 with an increase.
  
  
  CONCLUSIONS
  MRE had a positive diagnostic impact in patients under investigation for small bowel Crohn's disease and this influenced therapeutic strategy in 61% of the patients.
authors.affiliation: Department of Surgery, University College London Hospitals, NW1 2BU, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Hafeez
authors.forename: S
authors.initials: S
authors.lastname: Punwani
authors.forename: P
authors.initials: P
authors.lastname: Boulos
authors.forename: S
authors.initials: S
authors.lastname: Bloom
authors.forename: S
authors.initials: S
authors.lastname: McCartney
authors.forename: S
authors.initials: S
authors.lastname: Halligan
authors.forename: S A
authors.initials: SA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055815:Young Adult