Role of MR Enterography (MRE) in Small Bowel Diseases

Title: Role of MR Enterography (MRE) in Small Bowel Diseases

Authors: Dr Gaurav Gupta, Dr Shikha Sood, Dr Sanjiv Sharma, Dr Balraj Singh, Dr Vijay Thakur, Dr Brij Sharma

DOI: https://dx.doi.org/10.18535/jmscr/v5i7.108

Abstract

Introduction: Over recent years there have been significant advances in radiological techniques to better define small bowel lesions. Lack of ionising radiation, superior soft-tissue contrast resolution, capability of dynamic contrast enhanced imaging and capability of cine imaging to assess peristalsis makes MRE potential ideal imaging modality to assess small bowel pathologies.

Objective: The purpose of this article is to describe the role of MRE in diagnosis of small bowel diseases and guiding the course of management in patients of small bowel diseases.

Materials and Methods: MRE was performed on 30 patients who presented to outpatient department of surgery and general medicine with abdominal complaints. The level of agreement (%) of MR diagnosis with reference to a gold standard (histopathology, Fine Needle Aspiration Cytology, response to treatment) was calculated. The number and proportion of patients among whom the operating surgeons changed their course of management (that might have adopted in the absence of MR diagnosis) was calculated.

Observations: Four of 30 patients had Crohn's disease (CD) on MRE. Ten (33.3%) of the 30 patients who underwent MRE were operated. Adhesive bands (2.7%) was the most common operative finding. Histopathological examination was done in 43.4% of patients where CD (16.7%) was the most common diagnosis. Course of management changed in 56.7% of patients after MRE. There was 100% agreement between MR diagnosis and histopathology in all the cases except CD where there was 80% agreement.

Conclusions: MRE has high diagnostic accuracy comparable with histopathological diagnosis except in CD where diagnostic accuracy was 80%.MRE is very useful tool for clinician and surgeon in deciding the optimal course of management.

Keywords: MR enterography, small intestine, Crohn's disease.

References

1. Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008 Apr;247(1):64–79.

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 Gastro-enterol. 2005 Nov;100(11):2493–502.

3. Gupta A, Postgate AJ, Burling D, Ilangovan R, Marshall M, Phillips RKS, et al. A prospective study of MR enterography versus capsule endoscopy for the surveillance of adult patients with Peutz-Jeghers syndrome. AJR Am J Roentgenol. 2010 Jul;195(1):108–16.

4. Cronin CG, Lohan DG, Browne AM, Alhajeri AN, Roche C, Murphy JM. MR enterography in the evaluation of small bowel dilation. ClinRadiol. 2009 Oct;64(10):1026–34.

5. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D. Evaluation of Diffusion-weighted MR Imaging for Detection of Bowel Inflammation in Patients with Crohn’s Disease. Acad Radiol. 2009 May;16(5):597–603.

6. Fidler J. MR imaging of the small bowel. RadiolClin North Am. 2007 Mar;45(2): 317–31.

7. Friedrich C, Fajfar A, Pawlik M, Hoffstetter P, Rennert J, Agha A, et al. Magnetic resonance enterography with and without biphasic contrast agent enema compared to conventional ileocolonoscopy in patients with Crohn’s disease. Inflamm Bowel Dis. 2012 Oct;18(10):1842–8.

8. Young BM, Fletcher JG, Booya F, Paulsen S, Fidler J, Johnson CD, et al. Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr. 2008 Feb; 32 (1):32–8.

9. Sinha R, Rawat S. MRI enterography with divided dose oral preparation: Effect on bowel distension and diagnostic quality. Indian J Radiol Imaging. 2013;23(1):86–91.

10. Lauenstein TC, Schneemann H, Vogt FM, Herborn CU, Ruhm SG, Debatin JF. Optimization of oral contrast agents for MR imaging of the small bowel. Radiology. 2003 Jul;228(1):279–83.

11. Grand DJ, Kampalath V, Harris A, Patel A, Resnick MB, Machan J, et al. MR enterography correlates highly with colonoscopy and histology for both distal ileal and colonic Crohn’s disease in 310 patients. Eur J Radiol. 2012 May;81(5): e763-769.

12. Dinter DJ, Chakraborty A, Brade J, Back W, Neff KW, Singer MV, et al. Endoscopy and magnetic resonance imaging in patients with Crohn’s disease: a retrospective single-centre comparative study. Scand J Gastroenterol. 2008;43 (2):207–16.

13. Burkill GJC, Badran M, Al-Muderis O, Meirion Thomas J, Judson IR, Fisher C, et al. Malignant gastrointestinal stromal tumor: distribution, imaging features, and pattern of metastatic spread. Radiology. 2003 Feb;226(2):527–32.

14. Hersh MR, Choi J, Garrett C, Clark R. Imaging gastrointestinal stromal tumors. Cancer Control J Moffitt Cancer Cent. 2005 Apr;12(2):111–5.

15. Lee C-M, Chen H-C, Leung T-K, Chen Y-Y. Gastrointestinal stromal tumor: Computed tomographic features. World J Gastroenterol. 2004 Aug 15;10(16):2417–8.

16. Levy AD, Remotti HE, Thompson WM, Sobin LH, Miettinen M. Gastrointestinal stromal tumors: radiologic features with pathologic correlation. Radiogr Rev PublRadiolSoc N Am Inc. 2003 Apr;23(2):283–304, 456; quiz 532.

17. Matsuoka H, Takahara T, Masaki T, Sugiyama M, Hachiya J, Atomi Y. Preoperative evaluation by magnetic resonance imaging in patients with bowel obstruction. Am J Surg. 2002 Jun;183(6):614–7.

18. Maccioni F, Al Ansari N, Mazzamurro F, Barchetti F, Marini M. Surveillance of patients affected by Peutz-Jeghers syndrome: diagnostic value of MR enterography in prone and supine position. Abdom Imaging. 2012 Apr;37(2):279–87.

19. Boudiaf M, Soyer P, Terem C, Pelage JP, Maissiat E, Rymer R. Ct evaluation of small bowel obstruction. Radiogr Rev PublRadiolSoc N Am Inc. 2001 Jun;21(3):613–24. p

20. Kalra N, Agrawal P, Mittal V, Kochhar R, Gupta V, Nada R, et al. Spectrum of imaging findings on MDCT enterography in patients with small bowel tuberculosis. ClinRadiol. 2014 Mar;69(3):315–22.

21. Gomez D, Rahman S, Guillou P. Spontaneous Mesenteric Haematoma: A Diagnostic Challenge. Ann R Coll Surg Engl. 2006 May;88(3):W1–3.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search

Abstract

Call For Paper Volume 12 Issue 10 November 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles