The value of magnetic resonance enterography in diagnostic difficulties associated with Crohn's disease

Katarzyna B Biernacka; Dobromiła Barańska; Katarzyna Matera; Michał Podgórski; Elżbieta Czkwianianc; Katarzyna Szabelska-Zakrzewska; Inga Dziembowska; Piotr Grzelak

doi:10.5114/pjr.2021.104581

The value of magnetic resonance enterography in diagnostic difficulties associated with Crohn's disease

Pol J Radiol. 2021 Mar 3:86:e143-e150. doi: 10.5114/pjr.2021.104581. eCollection 2021.

Authors

Katarzyna B Biernacka¹, Dobromiła Barańska¹, Katarzyna Matera¹, Michał Podgórski¹, Elżbieta Czkwianianc², Katarzyna Szabelska-Zakrzewska², Inga Dziembowska³, Piotr Grzelak¹

Affiliations

¹ Department of Diagnostic Imaging, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
² Department of Gastroenterology, Allergology and Paediatrics, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
³ Department of Pathophysiology, Faculty of Pharmacy, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.

Abstract

Purpose: The diagnosis of Crohn's disease (CD), one of the inflammatory bowel diseases (IBD), along with ulcerative colitis (UC), is often challenging due to the limitations of small intestine visualisation. Magnetic resonance enterography (MRE) enables imaging of intraluminal and extraintestinal complications without ionizing radiation. The objective of this study is to select CD-related MRE features and determine the feasibility of this technique to indicate a group of patients that should be subjected to more invasive diagnostic procedures.

Material and methods: A total of 131 patients (mean age 25) underwent MRE, 60 of whom had been previously diagnosed with CD and 17 with UC. Additionally, 26 patients with suspected IBD and 28 with other or unknown pathologies were included in the study. Radiological reports of MRE examinations, effectuated using a 1.5-T field strength, were retrospectively analysed regarding radiological features of IBD, such as the following: bowel wall thickening, enhancement, comb sign, stricture, enlarged mesenteric nodes, inflammatory infiltration, and abnormal diffusion restriction in diffusion-weighted imaging. The statistical model was based on machine learning of the Kohonen map, together with univariate and multivariate analysis.

Results: The selected neuron (Neuron 3) incorporated 23 cases of CD, 9 of suspected IBD, 2 patients with UC, and 4 with other pathologies. The statistical analysis identified bowel wall thickening, intestinal stricture, and lymphadenopathy as the 3 MRE findings most associated with Neuron 3 (AUC = 0.919, p = 0.031).

Conclusions: Bowel wall thickening, stricture, and enlarged mesenteric lymph nodes in MRE are independent predictive factors for CD diagnosis; thus, patients presenting these features should undergo further examinations. MRE constitutes a powerful imaging modality in cases of suspected IBD.

Keywords: Crohn’s disease; inflammatory bowel disease; magnetic resonance enterography; ulcerative colitis.