title: PET/MR Versus PET/CT Imaging: Impact on the Clinical Management of Small-Bowel Crohn's Disease.
abstract: OBJECTIVE
  The aim of this study was to compare the accuracy and clinical impact of hybrid positron emission tomography [PET]/magnetic resonance-enterography [MR-E] and PET/computed tomography-enterography [CT-E] in patients with Crohn's disease [CD].
  
  
  METHODS
  A total of 35 patients with symptomatic small-bowel CD who were scheduled to undergo operation were evaluated before operation by same-day PET/CT-E and PET/MR-E. PET/MR-E was also compared with MR-E alone. Imaging accuracy for detecting pathological sites and discriminating between fibrotic and inflammatory strictures was assessed. Treatment was adjusted according to imaging findings and change in medical/surgical strategy was also evaluated.
  
  
  RESULTS
  PET/CT-E, PET/MR-E, and MR-E were equally accurate in detecting CD sites. PET/MR-E was more accurate in assessing extra-luminal disease [p = 0.002], which was associated with higher need for stoma [p = 0.022] and distant localisation [p = 0.002]. When the latter was observed, laparoscopy was started with hand-assisted device, reducing operative time [p = 0.022]. PET/MR-E was also more accurate in detecting a fibrotic component compared with PET/CT-E [p = 0.043] and with MR-E [p = 0.024]. Fibrosis was more frequently classified as inflammation with MR-E compared with PET/MR-E [p = 0.019]. Out of 8 patients with predominantly inflammatory CD who received medical treatment, 6 [75%] remained surgery free. Overall, 29 patients received surgery. At median follow-up of 9 [6-22] months, no recurrences occurred in either the medical or the surgical group.
  
  
  CONCLUSIONS
  Preoperative PET/MR-E imaging is highly accurate for assessing CD lesions before operation and contributed to clinical management of patients with small-bowel CD more often than PET/CT-E.
authors.affiliation: Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.affiliation: IRCCS-SDN , Naples, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Nicolai
authors.affiliation: Department of Radiology, Harvard medical school, Massachusetts General Hospital, Boston, MA.
authors.forename: Onofrio A
authors.initials: OA
authors.lastname: Catalano
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Severo
authors.initials: S
authors.lastname: Campione
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Francesco P
authors.initials: FP
authors.lastname: D'Armiento
authors.affiliation: IRCCS-SDN , Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Salvatore
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cuocolo
authors.affiliation: Unit of Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy fselvaggi@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D055815:Young Adult
keywords: Crohn’s disease; diagnosis; surgery; fibrosis; inflammation; magnetic resonance imaging; pathology