Abstract
Background/Aims: Some suggest MRI to be superior to ultrasound in Crohn’s disease. We analyzed how often MR enterography (MRE) following a routine ultrasound leads to a change in therapeutic decision. Material and Methods: We retrospectively evaluated 47 patients with Crohn’s disease undergoing routine ultrasound examination. Actual medical history, complete blood count, C-reactive protein (CRP), and sonographic findings were assessed independently by two specialists who retrospectively provided a therapeutic proposal. Additionally, all patients received MRE. Thereafter, the specialists had to provide a new therapeutic concept regarding all the available information. Results: Evaluation of the rectum was not successful by ultrasound, but MRE gave good results. Only 1 of 7 abscesses was identified sonographically. Three of the abscesses missed at sonography were localized in the perirectal/perianal region. MRE detected more inflamed bowel segments, but ultrasound assessment of anatomically fixed bowel parts showed good recognition by MRE. With increasing CRP values, we found more positive results of ultrasound and MRE. Therapeutic change was suggested in only 18 patients. Conclusions: Ultrasound should be performed by an experienced examiner, and a proctological examination should be added. MRE is justified in cases of discrepancy between clinical findings and the results of diagnostic ultrasound and, moreover, if Crohn’s lesions are suspected at sites proximal to the terminal or neoterminal ileum.
Journal Section:
Original Paper
References
1.
Schreyer AG, Geissler A, Albrich H, Schölmerich J, Feuerbach S, Rogler G, Völk M, Herfarth H: Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2004;2:491–497.
[PubMed]
2.
Bernstein CN, Greenberg H, Boult I, Chubey S, Leblanc C, Ryner L: A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn’s disease. Am J Gastroenterol 2005;100:2493–2502.
[PubMed]
3.
Frokjaer JB, Larsen E, Steffensen E, Nielsen AH, Drewes AM: Magnetic resonance imaging of the small bowel in Crohn’s disease. Scand J Gastroenterol 2005;40:832–842.
[PubMed]
4.
Rieber A, Wruk D, Potthast S, Nüssle K, Reinshagen M, Adler G, Brambs HJ: Diagnostic imaging in Crohn’s disease: comparison of magnetic resonance imaging and conventional imaging methods. Int J Colorectal Dis 2000;15:176–181.
[PubMed]
5.
Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL, Johnson CD, Barlow JM, Earnest F 4th: CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 2006;26:641–657.
[PubMed]
6.
Valette PJ, Rioux M, Pilleul F, Saurin JC, Fouque PL, Henry L: Ultrasonography of chronic inflammatory bowel diseases. Eur Radiol 2001;11:1859–1866.
[PubMed]
7.
Parente F, Maconi G, Bollani S, Anderloni A, Sampietro G, Cristaldi M, Franceschelli N, Bianco R, Taschieri AM, Bianchi Porro G: Bowel ultrasound in assessment of Crohn’s disease and detection of related small bowel strictures: a prospective comparative study versus X-ray and intraoperative findings. Gut 2002;50:490–495.
[PubMed]
8.
Serra C, Menozzi G, Labate AM, Giangregorio F, Gionchetti P, Beltrami M, Robotti D, Fornari F, Cammarota T: Ultrasound assessment of vascularization of the thickened terminal ileum wall in Crohn’s disease patients using a low-mechanical index real-time scanning technique with a second generation ultrasound contrast agent. Eur J Radiol 2007;62:114–121.
[PubMed]
9.
Migaleddu V, Quaia E, Scano D, Virgilio G: Inflammatory activity in Crohn disease: ultrasound findings. Abdom Imaging 2008;33:589–597.
[PubMed]
10.
Drews BH, Barth TF, Hänle MM, Akinli AS, Mason RA, Muche R, Thiel R, Pauls S, Klaus J, von Boyen G, Kratzer W: Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 2009;19:1379–1386.
[PubMed]
11.
Potthast S, Rieber A, Von Tirpitz C, Wruk D, Adler G, Brambs HJ: Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison. Eur Radiol 2002;12:1416–1422.
[PubMed]
12.
Pauls S, Gabelmann A, Schmidt SA, Rieber A, Mittrach C, Haenle MM, Brambs HJ, Kratzer W: Evaluating bowel wall vascularity in Crohn’s disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. Eur Radiol 2006;16:2410–2417.
[PubMed]
13.
Pascu M, Roznowski AB, Müller HP, Adler A, Wiedenmann B, Dignass AU: Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis 2004;10:373–382.
[PubMed]
14.
Martínez MJ, Ripollés T, Paredes JM, Blanc E, Martí-Bonmatí L: Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI. Abdom Imaging 2009;34:141–148.
[PubMed]
15.
Schreyer AG, Scheibl K, Heiss P, Feuerbach S, Seitz J, Herfarth H: MR colonography in inflammatory bowel disease. Abdom Imaging 2006;31:302–307.
[PubMed]
16.
Schober E, Turetschek K, Mostbeck G: Crohn’s disease: current imaging approach. Radiologe 1998;1:15–22.
17.
Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi S, Duca P, Conte D: Role of US in detection of Crohn disease: meta-analysis. Radiology 2005;236:95–101.
[PubMed]
18.
Negaard A, Sandvik L, Mulahasanovic A, Berstad AE, Klöw NE: Magnetic resonance enteroclysis in the diagnosis of small-intestinal Crohn’s disease: diagnostic accuracy and inter- and intra-observer agreement. Acta Radiol 2006;47:1008–1016.
[PubMed]
19.
Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G: Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 2006;16:2817–2827.
[PubMed]
20.
Miao YM, Koh DM, Amin Z, Healy JC, Chinn RJ, Zeegen R, Westaby D: Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease. Clin Radiol 2002;57:913–918.
[PubMed]
21.
Maconi G, Bollani S, Bianchi Porro G: Ultrasonographic detection of intestinal complications in Crohn’s disease. Dig Dis Sci 1996;41:1643–1648.
[PubMed]
22.
Gasche C, Moser G, Turetschek K, Schober E, Moeschl P, Oberhuber G: Transabdominal bowel sonography for the detection of intestinal complications in Crohn’s disease. Gut 1999;44:112–117.
[PubMed]
© 2010 S. Karger AG, Basel
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