title: Preoperative magnetic resonance enterography in predicting findings and optimizing surgical approach in Crohn's disease.
abstract: BACKGROUND
  Many Crohn's disease patients require surgery. Intraoperative detection of new lesions may lead to change in planned surgery. This study aimed to determine whether magnetic resonance enterography can optimize surgical planning and guide decision making in Crohn's disease.
  
  
  METHODS
  Seventy-five patients with complicated Crohn's disease were enrolled and underwent preoperative magnetic resonance enterography. Analysis included imaging accuracy and change in surgical strategy due to discordance with imaging findings.
  
  
  RESULTS
  Surgery was performed laparoscopically in 39/75 patients (52 %), with conversion to open surgery required in six (15 %). Concordance between observers was excellent (kappa value >0.8). Magnetic resonance enterography accuracy for stenosis, abscess, and fistula were all above 85 % in per-patient analysis. In 68/75 cases (90.7 %) surgery was correctly predicted. Conversely, in 7/75 cases (three false-positives and four false-negatives) surgical strategy (type of resection or strictureplasty, n = 5) and/or surgical approach (conversion from laparoscopy to open surgery, n = 2) changed due to discordance with magnetic resonance enterography findings.
  
  
  CONCLUSIONS
  Surgical strategy and approach are correctly predicted by magnetic resonance enterography in the majority of patients with complicated Crohn's disease.
authors.affiliation: Department of Surgery-IBD Surgery Unit, Humanitas Clinical and Research Center, via Manzoni 56, Rozzano (MI), 20089, Italy, antonino.spinelli@humanitas.it.
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.forename: Gionata
authors.initials: G
authors.lastname: Fiorino
authors.forename: Piero
authors.initials: P
authors.lastname: Bazzi
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Bonifacio
authors.forename: Sarah
authors.initials: S
authors.lastname: De Bastiani
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
authors.forename: Luca
authors.initials: L
authors.lastname: Balzarini
authors.forename: Laurent
authors.initials: L
authors.lastname: Peyrin-Biroulet
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Silvio
authors.initials: S
authors.lastname: Danese
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000209:etiology; D061887:Conversion to Open Surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000175:diagnosis* / Q000209:etiology; D007415:Intestinal Obstruction / Q000175:diagnosis* / Q000209:etiology; D007422:Intestines / Q000473:pathology*; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D008297:Male; D010347:Patient Care Planning; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D055815:Young Adult