Magnetic resonance enterography with and without biphasic contrast agent enema compared to conventional ileocolonoscopy in patients with Crohn's disease.
BACKGROUND
Magnetic resonance imaging (MRI) of the bowel is a valuable diagnostic tool for assessing disease activity in patients with inflammatory bowel disease (IBD). We compared magnetic resonance enterography (MRE) with and without water enema to conventional ileocolonoscopy to evaluate the advantage of a water enema for MRI diagnostics of Crohn's disease (CD).


METHODS
We prospectively evaluated 50 patients with known CD. MRE with enema was performed in 23 cases, whereas 27 patients received an MRE without enema. All patients underwent conventional ileocolonoscopy. We assessed the degree of inflammation in both modalities, evaluating up to seven bowel segments in each patient. We compared MRE with and without rectal enema to each other and to conventional ileocolonoscopy.


RESULTS
MRE achieved a sensitivity and specificity of 100% and 74%, respectively, for detection of inflammation in the terminal ileum with enema and a sensitivity and specificity of 72% and 87%, respectively, without enema. Considering the colon, MRE with enema had a sensitivity of 79% (specificity 96%), while the examination without enema showed a sensitivity of 38% (specificity 99%). MRE with enema proved statistically superior to MRE without enema in detecting inflammation in the terminal ileum, ascending colon, and rectum (P < 0.05).


CONCLUSIONS
MRE with enema is a valuable diagnostic tool for assessing inflammation in CD patients. Water enema is well tolerated and significantly improves detection of inflammation in the terminal ileum. Water enema should therefore be included in MRE protocols for CD patients.
University Medical Center Regensburg, Institute of Radiology, Regensburg, Germany. chris.friedrich@me.com
Chris
C
Friedrich
Alenka
A
Fajfar
Michael
M
Pawlik
Patrick
P
Hoffstetter
Janine
J
Rennert
Ayman
A
Agha
Ernst M
EM
Jung
Claudia
C
Ott
Christian
C
Stroszczynski
Andreas G
AG
Schreyer
D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging*; D003113:Colonoscopy; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis*; D004733:Enema; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011859:Radiography; D055815:Young Adult
D003287:Contrast Media