title: Magnetic resonance enterography in refractory iron deficiency anemia: a pictorial overview.
abstract: OBJECTIVE
  To highlight magnetic resonance enterography (MRE) for diagnosis of patients with refractory iron deficiency anemia and normal endoscopy results.
  
  
  METHODS
  Fifty-three patients diagnosed with iron deficiency anemia refractory to treatment and normal gastroscopy and colonoscopy results were admitted to this prospective study between June 2013 and December 2013. All patients underwent a standardized MRE examination with a 1.5 Tesla magnetic resonance imaging system using two six-channel phased-array abdominal coils. Adequate bowel distention and fast imaging sequences were utilized to achieve diagnostic accuracy. All segments of the small bowel, duodenum, jejunum, and ileum were examined in detail. All cases were examined independently by two radiologists with > 5 years of experience in abdominal magnetic resonance imaging. A consensus reading was performed for each patient following image examination. Both radiologists were blinded to patient history, laboratory findings, and endoscopy results.
  
  
  RESULTS
  Twenty (37.7%) male and 33 (62.3%) female patients were included in the study. The mean age of the patients was 52.2 ± 13.6 years (range: 19-81 years, median 51.0). The age difference between the male and female patient groups was not statistically significant (54.8 ± 16.3 years vs 50.7 ± 11.7 years). MRE results were normal for 49 patients (92.5%). Four patients had abnormal MRE results. One patient with antral thickening was diagnosed with antral gastritis in the second-look gastroscopy. One patient had focal wall thickening in the 3(rd) and 4(th) portions of the duodenum. The affected areas were biopsied in a subsequent duodenoscopy, and adenocarcinoma was diagnosed. One patient had a fistula and focal contrast enhancement in the distal ileal segments, consistent with Crohn's disease. One patient had focal wall thickening with luminal narrowing in the mid-jejunum that was later biopsied during a double-balloon enteroscopy, and lymphoma was diagnosed.
  
  
  CONCLUSIONS
  MRE is a non-invasive and effective alternative for evaluating possible malignancies of the small intestines and can serve as a guide for a second-look endoscopy.
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Ismet
authors.initials: I
authors.lastname: Cengic
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Derya
authors.initials: D
authors.lastname: Tureli
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Hilal
authors.initials: H
authors.lastname: Aydin
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Bugdayci
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Nese
authors.initials: N
authors.lastname: Imeryuz
authors.affiliation: Ismet Cengic, Derya Tureli, Hilal Aydin, Onur Bugdayci, Davut Tuney, Department of Radiology, Marmara University Pendik Research and Education Hospital, 34899 Istanbul, Turkey.
authors.forename: Davut
authors.initials: D
authors.lastname: Tuney
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D001706:Biopsy; D003113:Colonoscopy; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000628:therapy; D005773:Gastroscopy; D006801:Humans; D007414:Intestinal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D007422:Intestines / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D055815:Young Adult
keywords: Adenocarcinoma; Anemia; Crohn’s disease; Double-balloon enteroscopy; Gastritis; Lymphoma; Magnetic resonance enterography; Small intestine