Computed tomography and magnetic resonance imaging in the diagnosis of the small and large intestine strictures in Crohn’s disease. Radiological semiotics and assessment of the inflammation activity

Rationale: Crohn's disease is characterized by continuous severe course, and in a half of the patients is associated with formation of strictures that are difcult to treat and signifcantly decrease quality of life. Difculties during the diﬀerentiation between inﬂammation-related and fbrostenotic strictures and divergent approaches to their treatment in patients with Crohn's disease indicate the need in precise diagnostics and systematization of the radiological semiotics of strictures.Aim: To propose radiological semiotics of the small and large intestine strictures based on the results of multiaxial computed tomography (MACT) and magnetic resonance imaging (MRI).Materials and methods: MACT and MRI visualization was performed in 40 patients with a stenotic type of Crohn's disease.Results: The radiological signs of the strictures were classifed into two main groups: intestinal and extra-intestinal. They were systematized according to nine criteria, such as character of formation, etiology, number, inﬂammation grade, extension, shape, and location, presence of ileus and presence of other complications. The inﬂammation activity in the intestinal wall was evaluated during the postcontrast assessment: active inﬂammation in the arterial phase (at 25 seconds after administration of the contrast agent), chronic inﬂammation in the delayed phase (at 10 minutes). The MRI results were cross-checked with those of MACT. At the precontrast stage, MRI was more informative as per the width of the intestinal lumen, whereas MACT was preferential in the diagnosis of fat infltration of the intestinal wall. Post-contrast MACT and MRI were diagnostically equivalent. The most indicative for active inﬂammation were diﬀuse weighed MRI images, arterial phase MACT and MRI, whereas chronic inﬂammation and wall fbrosis were better diagnosed at the delayed phase (at 10 minutes) of MACT and MRI. Both methods (MACT and MRI) could not diﬀerentiate between the submucous and muscular layers of the intestinal wall. Mixed type of inﬂammation was seen in the walls of intestinal strictures: chronic inﬂammation dominated in the intermediate, most extensive part of a stricture and remained stable during the dynamic follow-up, whereas active inﬂammation was found in the marginal parts of the strictures, which were most susceptible to changes during the follow-up.Conclusion: Based on a set of certain signs obtained by radiological visualization, we propose a registry for stricture assessment based on evaluation of the inﬂammation activity.

Download Full-text

Magnetic resonance imaging for follow-up of Crohn’s disease

World Chinese Journal of Digestology ◽

10.11569/wcjd.v22.i10.1351 ◽

2014 ◽

Vol 22 (10) ◽

pp. 1351

Author(s):

Hong Li ◽

Xiao-Chun Yang ◽

Wen Tang ◽

Hong-Yan Pang ◽

Jun-Kang Shen ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Resonance Imaging

Download Full-text

Imaging Modalities for the Noninvasive Assessment of Fibrosis in Crohn's Disease

The Scientific World JOURNAL ◽

10.1100/2012/450151 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Cristina Stasi ◽

Massimo Falchini ◽

Stefano Milani

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Power Doppler ◽

Resonance Imaging ◽

Indication For Surgery ◽

Noninvasive Methods ◽

Additional Advantage ◽

Contrast Enhanced ◽

Bowel Ultrasound

The development of strictures in Crohn's disease is a main cause of hospitalization and often represent an indication for surgery. The differentiation between inflammatory and fibrotic strictures is useful to determine the optimal treatment. Today, the availability of noninvasive methods to assess the presence and extension of strictures offers new tools for the diagnosis and follow-up of the disease. Bowel ultrasound, power doppler ultrasound, contrast-enhanced ultrasound, magnetic resonance imaging offer the additional advantage that they do not expose patients to ionizing radiation. In this paper we provide an update on the accuracy of these noninvasive methods for the diagnosis of Crohn's disease.

Download Full-text

MAGNETIC RESONANCE IMAGING OF THE LARGE AND SMALL INTESTINES

Modern medical technologies ◽

10.34287/mmt.3(46).2020.1 ◽

2020 ◽

Vol 46 (3) ◽

pp. 4

Author(s):

A. S. Sementsov ◽

V. V. Ponomarenko

Keyword(s):

Magnetic Resonance Imaging ◽

Small Intestine ◽

Crohn’S Disease ◽

Magnetic Resonance ◽

Crohn's Disease ◽

Large Intestine ◽

Pathological Changes ◽

Resonance Imaging ◽

Colon Tumors ◽

Small And Large Intestine

Abstract Purpose of the work is to show the possibilities of radiation diagnosis of the normal anatomy of the small and large intestine, as well as their pathological changes through the use of MRI (Hydro-MRI). Material and methods. Thirty patients were examined by the method of Hydro-MRI. All patients underwent magnetic resonance imaging on a device with a magnetic induction of 1.5T. To carry out Hydro-MRI, we used T2-weighted sequences, such as a one-time fast spin echo signal obtained in several planes, STIR sequences in three mutually perpendicular sequences, so that, edema wall can be estimated with additional diffusion-weighted images. Results. Twenty patients with the manifestations of Crohn's disease in the form of terminal ileitis, presence of interlope fistulous passages, paraproctitis (fistulous form) were detected. Colon tumors were detected in 8 patients, recurrence of gastrointestinal stromal tumor (GIST) of the small intestine in the anastomosis zone was detected in one patient, and no pathological changes were detected in one patient. Findings. Hydro-MRI allows visualizing the mass of the small, large intestine and determining the degree of invasion of the intestinal wall and surrounding tissues. Enterography using magnetic resonance enterography has become the most effective methods for visualizing the small intestine in patients with Crohn's disease and can visualize inflammation of the intramural or proximal small intestine in about 50% of patients with Crohn's disease who have undergone endoscopically normal studies. Hydro-MRI is indicated for Crohn's disease and for determining the degree of inflammatory activity. Recent evidence suggests that cross-section visualization may be useful in determining response to therapy, assessing bowel healing and monitoring disease progression. Also, according to researchers at the Medical Imaging Center, University College London, the quantitative motility of the small intestine is an objective biomarker of endoscopic and histopathological inflammatory activity in Crohn's disease and is comparable to previously confirmed estimates of MRI activity enhanced by gadolinium. The final ileal mobility indicator showed a good correlation with endoscopic and histopathological activity in Crohn's disease. The study is painless, no radiation load. Hydro-MRI is a method of choice, when it is impossible to conduct an X-ray examination of the intestine, the inability/uninformativeness of an endoscopic examination of the small, large intestine. Along with video capsular endoscopy, it allows visualization of all departments of the small and large intestine [1]. Keywords: Hydro-MRI or hydro-magnetic resonance imaging, Crohn's disease, small bowel and colon tumors.

Download Full-text

Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

Canadian Journal of Gastroenterology ◽

10.1155/2000/958086 ◽

2000 ◽

Vol 14 (2) ◽

pp. 138-143 ◽

Cited By ~ 16

Author(s):

Hugh J Freeman ◽

Katy J Freeman

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Parenteral Nutrition ◽

Avascular Necrosis ◽

Intestinal Resection ◽

Resonance Imaging ◽

Small Intestinal ◽

Metastatic Colon Carcinoma

Avascular necrosis (osteonecrosis) occurs in Crohn’s disease, but the rate of this particular complication is not known. Over 20 years, 877 patients with Crohn’s disease, 492 women (56.1%) and 385 men (43.9%), were evaluated with patient follow-up data available for a mean of 7.8 years. In this group, four men were seen with osteonecrosis. No woman was affected. All patients had typical radiological, magnetic resonance imaging or pathological changes of osteonecrosis involving the femoral heads, while two also had superimposed avascular necrosis involving the humeral heads. Patient ages ranged from 19 to 36 years at the time of diagnosis of their Crohn’s disease, and all were white. In one patient, disease was confined to the colon, while three patients had disease involving the terminal ileum and colon. Disease behaviour in two patients was classified as penetrating because of concomitant ischiorectal abscesses, while one patient developed a metastatic colon carcinoma. Ankylosing spondylitis was present in two patients, but no other extraintestinal manifestations developed. Two patients received corticosteroids as well as parenteral nutrition during the course of their disease. Two patients did not receive corticosteroids or parenteral nutrition. Of 877 patients with Crohn’s disease, 484 (55.1%) received corticosteroids during the course of the disease, 196 (22.4%) received at least one course of parenteral nutrition, and 125 (14.3%) received both corticosteroids and parenteral nutrition. A total of 311 patients (35.5%) had at least one small intestinal resection. The overall rate of avascular necrosis in Crohn’s disease was less than 0.5% but for men with Crohn’s disease was about 1%. In this series, risk of osteonecrosis could not be attributed to corticosteroid use, parenteral nutrition or both forms of therapy administered together. Small intestinal resection with loss of small intestinal absorptive area was not a risk factor for the development of osteonecrosis. Avascular necrosis (or osteonecrosis) is a very rare extraintestinal osseous complication that may occur in Crohn’s disease, independent of previously reported risk factors, including corticosteroids or parenteral nutrition with lipid emulsions.

Download Full-text

Validity of Capsule Endoscopy in Monitoring Therapeutic Interventions in Patients with Crohn’s Disease

Journal of Clinical Medicine ◽

10.3390/jcm7100311 ◽

2018 ◽

Vol 7 (10) ◽

pp. 311 ◽

Cited By ~ 4

Author(s):

Masanao Nakamura ◽

Takeshi Yamamura ◽

Keiko Maeda ◽

Tsunaki Sawada ◽

Yasuyuki Mizutani ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Medical Treatment ◽

Capsule Endoscopy ◽

Mucosal Damage ◽

Mucosal Healing ◽

Additional Treatment ◽

Therapeutic Interventions ◽

Active Inflammation

Mucosal healing in Crohn’s disease (CD) can be evaluated by capsule endoscopy (CE). However, only a few studies have utilized CE to demonstrate the therapeutic effect of medical treatment. We sought to evaluate the validity of using CE to monitor the effect of medical treatment in patients with CD. One hundred (n = 100) patients with CD were enrolled. All patients had a gastrointestinal (GI) tract patency check prior to CE. Patients with baseline CE Lewis score (LS) ≤ 135 were included in the non-active CD group and ended the study. In those with LS > 135 (active CD group), additional treatment was administered, regardless of symptoms, as per the treating clinician’s advice. Patients of the active CD group underwent follow-up CE assessment 6 months later. Out of 92 patients with confirmed GI patency who underwent CE, 40 (43.4%) had CE findings of active inflammation. Of 29 patients with LS > 135 who received additional medications and underwent follow-up CE, improvement of the LS was noted in 23 (79.3%) patients. Eleven patients were asymptomatic but received additional medications; 8 (72.7%) had improvement of the LS. This study demonstrated that additional treatment even for patients with CD in clinical remission and active small-bowel inflammation on CE can reduce mucosal damage.

Download Full-text