HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Google Scholar Articles by Siddiki, H. A. Articles by Mandrekar, J. N. PubMed PubMed Citation Articles by Siddiki, H. A. Articles by Mandrekar, J. N. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Prospective Comparison of State-of-the-Art MR Enterography and CT Enterography in Small-Bowel Crohn's Disease

¹ Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905.
² Miles and Shirley Fiterman Center for Digestive Diseases, Mayo Clinic, Rochester, MN.
³ Division of Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.

View larger version (166K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —False-negative MR findings in 29-year-old man who presented with fluctuating abdominal symptoms of 9 years' duration. Ileocolonoscopy was performed for suspicion of Crohn's disease but did not show any abnormalities and biopsies were not performed. Axial CT enterography image was interpreted as positive for 20-cm-long small-bowel segment with active inflammation consisting of mucosal hyperenhancement and mural wall thickening (arrow) 10 cm proximal to ileocecal valve.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —False-negative MR findings in 29-year-old man who presented with fluctuating abdominal symptoms of 9 years' duration. Ileocolonoscopy was performed for suspicion of Crohn's disease but did not show any abnormalities and biopsies were not performed. Coronal 2D fast spoiled gradient-recalled echo MR enterography image was interpreted as negative but in retrospect shows wall thickening and hyperenhancement (arrow), findings similar to CT enterography. This perceptual error could have been secondary to proximity of pelvic structures without intervening mesenteric fat and decreased bowel distention.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —False-negative MR findings in 29-year-old man who presented with fluctuating abdominal symptoms of 9 years' duration. Ileocolonoscopy was performed for suspicion of Crohn's disease but did not show any abnormalities and biopsies were not performed. Coronal 2D steady-state fast spin-echo MR enterography image was interpreted as negative but in retrospect shows wall thickening (arrows), finding similar to CT enterography. This perceptual error could have been secondary to proximity of pelvic structures without intervening mesenteric fat and decreased bowel distention.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Positive CT enterography and MR enterography findings with failed intubation in 23-year-old man with prior small-bowel resections. Axial CT enterography image was interpreted as positive with wall thickening and mucosal hyperenhancement (arrow). Endoscopist was unable to intubate terminal ileum.

View larger version (173K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Positive CT enterography and MR enterography findings with failed intubation in 23-year-old man with prior small-bowel resections. Axial 3D liver acquisition volume acceleration (LAVA) MR enterography image was interpreted as positive with wall thickening and mucosal hyperenhancement (arrow). Endoscopist was unable to intubate terminal ileum.

View larger version (95K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —False-negative ileoscopy in 49-year-old woman with diarrhea and 40-year history of known Crohn's disease and extensive bowel resections who underwent evaluation to rule out short gut syndrome from active disease. Ileocolonoscopy did not show evidence of active Crohn's disease. Axial CT enterography image shows active inflammation with wall thickening and hyperenhancement (arrow) just proximal to ileocolonic anastomosis.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —False-negative ileoscopy in 49-year-old woman with diarrhea and 40-year history of known Crohn's disease and extensive bowel resections who underwent evaluation to rule out short gut syndrome from active disease. Ileocolonoscopy did not show evidence of active Crohn's disease. Axial single-shot fast spin-echo MR enterography image shows active inflammation with wall thickening and deep ulceration (arrow) just proximal to ileocolonic anastomosis.

View larger version (201K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Proximal small-bowel inflammation in 45-year-old steroid-dependent man with known diagnosis of Crohn's disease who developed obstructive symptoms. Ileocolonoscopy showed patchy involvement from sigmoid to cecum, but ileum was reported to be normal 15 cm beyond ileocecal valve. Coronal CT enterography image shows active disease (arrowheads) in proximal small bowel with scattered areas of wall thickening and increased enhancement.

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Proximal small-bowel inflammation in 45-year-old steroid-dependent man with known diagnosis of Crohn's disease who developed obstructive symptoms. Ileocolonoscopy showed patchy involvement from sigmoid to cecum, but ileum was reported to be normal 15 cm beyond ileocecal valve. Coronal 3D liver acquisition volume (LAVA) images show active disease (arrows) in proximal small bowel with scattered areas of wall thickening and increased enhancement.

View larger version (170K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Proximal small-bowel inflammation in 45-year-old steroid-dependent man with known diagnosis of Crohn's disease who developed obstructive symptoms. Ileocolonoscopy showed patchy involvement from sigmoid to cecum, but ileum was reported to be normal 15 cm beyond ileocecal valve. Coronal 3D liver acquisition volume (LAVA) images show active disease (arrows) in proximal small bowel with scattered areas of wall thickening and increased enhancement.

View larger version (189K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —False-negative ileoscopy with sampling error. 63-year-old symptomatic woman who presented with long history of known Crohn's disease. Ileocolonoscopy and biopsy did not show any evidence of active disease. Negative biopsy and presence of active disease seen on cross-sectional imaging well within reach of endoscope raise possibility of sampling error. Coronal CT enterography image shows wall thickening and mucosal hyperenhancement (arrow) just proximal to ileoascending anastomosis.

View larger version (154K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —False-negative ileoscopy with sampling error. 63-year-old symptomatic woman who presented with long history of known Crohn's disease. Ileocolonoscopy and biopsy did not show any evidence of active disease. Negative biopsy and presence of active disease seen on cross-sectional imaging well within reach of endoscope raise possibility of sampling error. Coronal 2D fast spoiled gradient-recalled echo (FSPGR) MR enterography image shows wall thickening and mucosal hyperenhancement (arrow) just proximal to ileoascending anastomosis. Also note deep ulcerations (arrowhead).

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —False-negative ileoscopy with sampling error. 63-year-old symptomatic woman who presented with long history of known Crohn's disease. Ileocolonoscopy and biopsy did not show any evidence of active disease. Negative biopsy and presence of active disease seen on cross-sectional imaging well within reach of endoscope raise possibility of sampling error. Axial 2D FSPGR MR enterography image shows wall thickening and stratified mucosal hyperenhancement (arrow) just proximal to ileoascending anastomosis.

View larger version (68K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —False-negative ileoscopy with sampling error. 63-year-old symptomatic woman who presented with long history of known Crohn's disease. Ileocolonoscopy and biopsy did not show any evidence of active disease. Negative biopsy and presence of active disease seen on cross-sectional imaging well within reach of endoscope raise possibility of sampling error. Axial 2D true fast imaging with steady-state precession MR enterography image shows wall thickening (arrow) just proximal to ileoascending anastomosis.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati