OJRad  Vol.5 No.2 , June 2015
Comparison of a New Magnetic Resonance Imaging Protocol and Magnetic Resonance Follow-Through in Patients with Inflammatory Bowel Disease—A Prospective Pilot Study
Abstract: Objective: Inflammatory bowel disease (IBD) is a chronic disease, consisting of two main subgroups: Crohn’s disease (CD) and ulcerative colitis (UC). Imaging is an essential component in the treatment of IBD and is used repeatedly to determine activity and severity of inflammatory lesions. The aim of our study was to prospectively obtain pilot data on the accuracy of magnetic resonance imaging with no oral contrast (MRI-NOC) and magnetic resonance follow-through (MRFT) using endoscopy as the reference standard. Materials and Methods: Patients diagnosed with CD and UC referred to magnetic resonance imaging (MRI) were included in this study population. For the evaluation, the bowel was divided into 9 segments. Two radiologists, blinded to clinical findings, evaluated bowel wall thickness, diffusion weighted imaging and mural hyperenhancement. Results: 14 patients (9 males and 5 females; median age 41; range 20 - 62) underwent both type of MRI examinations; 9 had CD and 5 had UC. The overall sensitivity for small bowel was zero for both MRI protocols, as neither identified any lesions, whereas in colon the sensitivity ranged from 7% to 29% in MRI-NOC and 14% - 29% in MRFT. Specificity and accuracy in MRI-NOC ranged from 78% to 98% and 74% - 93%, respectively, in small bowel, and from 90% to 96% and 77% - 82%, respectively, in colon. Specificity and accuracy in MRFT ranged from 83% to 100% and 79% - 95%, respectively, in small bowel, while it ranged from 93% to 97% and 81% - 85%, respectively, in colon. Conclusion: The location of lesions in the colon combined with the lack of oral contrast in the colon renders MRFT and MRI-NOC functionally identical.
Cite this paper: Jesuratnam-Nielsen, K. , Løgager, V. , Munkholm, P. , Nielsen, Y. and Thomsen, H. (2015) Comparison of a New Magnetic Resonance Imaging Protocol and Magnetic Resonance Follow-Through in Patients with Inflammatory Bowel Disease—A Prospective Pilot Study. Open Journal of Radiology, 5, 117-124. doi: 10.4236/ojrad.2015.52018.

[1]   Jakobsen, C., Wewer, V., Urne, F., Andersen, J., Faerk, J., Kramer, I., et al. (2008) Incidence of Ulcerative Colitis and Crohn’s Disease in Danish Children: Still Rising or Levelling Out? Journal of Crohn’s and Colitis, 2, 152-157.

[2]   Shivananda, S., Lennard-Jones, J., Logan, R., Fear, N., Price, A., Carpenter, L., et al. (1996) Incidence of Inflammatory Bowel Disease across Europe: Is There a Difference between North and South? Results of the European Collaborative Study on Inflammatory Bowel Disease (EC-IBD). Gut, 39, 690-697.

[3]   Pedersen, N., Elkjaer, M., Duricova, D., Burisch, J., Dobrzanski, C., Andersen, N.N., et al. (2012) eHealth: Individualisation of Infliximab Treatment and Disease Course via a Self-Managed Web-Based Solution in Crohn’s Disease. Alimentary Pharmacology Therapeutics, 36, 840-849.

[4]   Riccioni, M.E., Urgesi, R., Cianci, R., Bizzotto, A., Spada, C. and Costamagna, G. (2012) Colon Capsule Endoscopy: Advantages, Limitations and Expectations. Which Novelties? World Journal of Gastrointestinal Endoscopy, 4, 99-107.

[5]   Viera, A.J. and Garrett, J.M. (2005) Understanding Interobserver Agreement: The Kappa Statistic. Family Medicine, 37, 360-363.

[6]   R Core Team (2013) R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna. ISBN 3-900051-07-0.

[7]   Jesuratnam-Nielsen, K., Rezanavaz-Gheshlagh, B., Løgager, V.B., Munkholm, P. and Thomsen, H.S. (2015) Plain Magnetic Resonance Imaging as an Alternative in Evaluating Inflammation and Bowel Damage in Inflammatory Bowel Disease—A Prospective Comparison with Conventional Magnetic Resonance Follow-Through. Scandinavian Journal of Gastroenterology, 50, 519-527.

[8]   Røseth, A.G., Aadland, E. and Jahnsen, J.R.N. (1997) Assessment of Disease Activity in Ulcerative Colitis by Faecal Calprotectin, a Novel Granulocyte Marker Protein. Digestion, 58, 176-180.

[9]   Costa, F., Mumolo, M.G., Ceccarelli, L., Bellini, M., Romano, M.R., Sterpi, C., et al. (2005) Calprotectin Is a Stronger Predictive Marker of Relapse in Ulcerative Colitis than in Crohn’s Disease. Gut, 54, 364-368.

[10]   Lewis, J.D. (2011) The Utility of Biomarkers in the Diagnosis and Therapy of Inflammatory Bowel Disease. Gastroenterology, 140, 1817-1826.

[11]   Benitez, J.M., Meuwis, M.A., Reenaers, C., Van Kemseke, C., Meunier, P. and Louis, E. (2013) Role of Endoscopy, Cross-Sectional Imaging and Biomarkers in Crohn’s Disease Monitoring. Gut, 62, 1806-1816.

[12]   Jensen, M.D., Kjeldsen, J. and Nathan, T. (2011) Fecal Calprotectin is Equally Sensitive in Crohn’s Disease Affecting the Small Bowel and Colon. Scandinavian Journal of Gastroenterology, 46, 694-700.

[13]   Lobatón, T., López-García, A., Rodríguez-Moranta, F., Ruiz, A., Rodríguez, L. and Guardiola, J. (2013) A New Rapid Test for Fecal Calprotectin Predicts Endoscopic Remission and Postoperative Recurrence in Crohn’s Disease. Journal of Crohn’s and Colitis, 7, e641-e651.

[14]   Tibble, J., Teahon, K., Thjodleifsson, B., Roseth, A., Sigthorsson, G., Bridger, S., et al. (2000) A Simple Method for Assessing Intestinal Inflammation in Crohn’s Disease. Gut, 47, 506-513.

[15]   El-Etreby, S., Farag, R., Hakim, H., Ragab, M., Abdeen, H., Alsayed, S., et al. (2013) A New Cutoff Value for Fecal Calprotectin Level in Differentiating Functional from Organic Causes of Chronic Diarrhea. Tanta Medical Journal, 41, 336-341.

[16]   Nancey, S., Boschetti, G., Moussata, D., Cotte, E., Peyras, J., Cuerq, C., et al. (2013) Neopterin is a Novel Reliable Fecal Marker as Accurate as Calprotectin for Predicting Endoscopic Disease Activity in Patients with Inflammatory Bowel Diseases. Inflammatory Bowel Diseases, 19, 1043-1052.

[17]   Tibble, J.A. and Bjarnason, I. (2001) Non-Invasive Investigation of Inflammatory Bowel Disease. World Journal of Gastroenterology, 7, 460-465.

[18]   Gaya, D.R., Lyon, T.D.B., Duncan, A., Neilly, J.B., Han, S., Howell, J., et al. (2005) Faecal Calprotectin in the Assessment of Crohn’s Disease Activity. QJM, 98, 435-441.

[19]   Maccioni, F., Bruni, A., Viscido, A., Colaiacomo, M.C. and Cocco, A. (2006) MR Imaging in Patients with Crohn Disease: Value of T2- versus T1-Weighted Gadolinium-Enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent. Radiology, 238, 517-530.