Prospective Comparison of State-of-the-Art MR Enterography and CT Enterography in Small-Bowel Crohn’s Disease
June 25th, 2009 Posted by: admin
OBJECTIVE. The objective of our study was to prospectively obtain
pilot data on the accuracy of MR enterography for detecting small-bowel
Crohn’s disease compared with CT enterography and with a clinical reference
standard based on imaging, clinical information, and ileocolonoscopy.
SUBJECTS AND METHODS. The study group for this blinded prospective
study was composed of 33 patients with suspected active Crohn’s ileal
inflammation who were scheduled for clinical CT enterography and
ileocolonoscopy and had consented to also undergo MR enterography. The MR
enterography and CT enterography examinations were each interpreted by two
radiologists with disagreements resolved by consensus. The reports from
ileocolonoscopy with or without mucosal biopsy were interpreted by a
gastroenterologist. The reference standard for the presence of small-bowel
Crohn’s disease was based on the final clinical diagnosis by the referring
gastroenterologist after reviewing all of the available information.
RESULTS. All 33 patients underwent CT enterography and
ileocolonoscopy, 30 of whom also underwent MR enterography. The sensitivities
of MR enterography and CT enterography for detecting active small-bowel
Crohn’s disease were similar (90.5% vs 95.2%, respectively; p =
0.32). The image quality scores for MR enterography examinations were
significantly lower than those for CT enterography (p = 0.005). MR
enterography and CT enterography identified eight cases (24%) with a final
diagnosis of active small-bowel inflammation in which the ileal mucosa
appeared normal at ileocolonoscopy. Furthermore, enterography provided the
only available imaging in three additional patients who did not have ileal
intubation.
CONCLUSION. MR enterography and CT enterography have similar
sensitivities for detecting active small-bowel inflammation, but image quality
across the study cohort was better with CT. Cross-sectional enterography
provides complementary information to ileocolonoscopy.
