title: Sensitivity and specificity of magnetic resonance enterography in the clinical management of fistulizing Crohn's disease.
abstract: BACKGROUND
  High diagnostic accuracy is reported for magnetic resonance enterography (MRE) in Crohn's disease (CD), but few studies have evaluated its role in abdominal fistulae. The primary aim of this study was to assess the reliability of MRE in the identification of internal fistulae in CD.
  
  
  METHODS
  One hundred and eighty-six patients with moderate CD (CD Activity Index : 250-400) were prospectively selected from the inflammatory bowel disease clinic of Parma University Hospital. Eligible patients had already undergone nutritional screening, pancolonoscopy, and computed tomography enterography (CTE) in the month before enrollment. MRE was performed according to the study protocol. Additional fluoroscopic contrast-enhanced studies or surgical evaluation were used for discordance between CTE and MRE results. A consensus committee resolved equivocal findings. Surgical findings and/or fluoroscopic contrast-enhanced studies together with the clinical data were considered the composite "reference standard" to which the results of MRE were compared.
  
  
  RESULTS
  MRE identified 22 internal fistulae in 21 patients (11%), of whom 4 (19%) also had perianal fistulae and found 7 abscesses (33%). Forty-one (22%) additional patients with perianal fistulae were identified. Thirteen patients (57%) with internal fistulae required enteral nutrition support. No statistically significant differences were found between MRE and CTE in fistula detection. There was also no significant difference between MRE and the composite diagnosis in those who underwent surgery (n = 8) and/or contrast-enhanced studies (n = 7).
  
  
  CONCLUSIONS
  CTE and MRE accurately detect internal fistulae in CD. MRE is preferable because it avoids radiation. Reliable identification of internal fistulae by MRE should permit earlier and improved treatment.
authors.affiliation: Department of Gastroenterology, University College London Hospitals, London, United Kingdom.
authors.forename: Cinzia
authors.initials: C
authors.lastname: Papadia
authors.forename: Erica
authors.initials: E
authors.lastname: Maffei
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Rio
authors.forename: Stuart
authors.initials: S
authors.lastname: Taylor
authors.forename: Saverio
authors.initials: S
authors.lastname: Caini
authors.forename: Chiara
authors.initials: C
authors.lastname: Montana
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coruzzi
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzè
authors.forename: Filippo
authors.initials: F
authors.lastname: Cademartiri
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
mesh_terms: D000328:Adult; D000368:Aged; D023881:Colonography, Computed Tomographic; D003424:Crohn Disease / Q000150:complications* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012006:Rectovaginal Fistula / Q000175:diagnosis* / Q000209:etiology; D012680:Sensitivity and Specificity