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      Comparison of MR Enteroclysis with Colonoscopy in Crohn's Disease-First Locust Bean Gum Study from Turkey

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          Abstract

          Background/Aim:

          The aim of this study was to compare magnetic resonance enteroclysis (MRE) findings with those of colonoscopy, using locust bean gum (LBG) as an oral contrast agent in the diagnosis and follow-up of patients with Crohn's disease.

          Materials and Methods:

          Nine patients with histologically proven Crohn's disease were enrolled in this study; MRE was performed within a week of colonoscopy. All patients were examined using a 1.5 T MR Scanner after per os administration of 850 mL of a combination of LBG and mannitol. After intravenous administration of 50 mg Eritromisin and 40 mg Scopolamine, images were obtained using a T2-weighted, balanced GRE, fat-suppressed T1-weighted sequence, before and after intravenous gadolinium administration. Bowel wall thickness and enhancement of inflamatory bowel wall were measured.

          Results:

          The oral ingestion of LBG was well tolerated and allowed optimal small and large bowel distention in all patients. MR findings correlated with the colonoscopy results. Additional inflammatory lesions of the colon and mesenteric inflamatory changes such as lymphadenopathy, conglomerate tumor, and fistulas were demonstrated. Contrast enhancement of the affected bowel wall was markedly increased and positive correlation was obtained between bowel wall enhancement and bowel wall thickness.

          Conclusion:

          Gadolinium-enhanced MRE with oral locust bean gum is very efficient in the detection and follow-up of the intestinal and extraintestinal findings of Crohn's disease.

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          Most cited references9

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          MR imaging evaluation of the activity of Crohn's disease.

          The purpose of this study was to evaluate the sensitivity and specificity of MR imaging in assessing the activity of Crohn's disease. Thirty symptomatic patients with Crohn's disease but uncertain disease activity were prospectively examined using MR imaging. Twenty-nine patients were scored using the Crohn's disease activity index. Six hundred milliliters of water orally and 1 mg of glucagon intramuscularly were given before imaging. Breath-hold images were obtained using T2-weighted turbo spin-echo, T1-weighted fast low-angle shot, and fat-suppressed gadolinium-enhanced T1-weighted fast low-angle shot sequences. Images were assessed by two radiologists who were unaware of the patient's symptoms, clinical scoring, and other imaging tests, and who reached a consensus about the imaging findings (bowel wall thickening, bowel wall enhancement, and perienteric changes) and determined the absence or presence of active disease in each patient. MR imaging findings were correlated with endoscopy and surgery. Twenty-three patients had active disease and seven patients had inactive disease. One hundred twenty-four of a total of 168 bowel segments were examined with both MR imaging and endoscopy or surgery. On a per patient basis, MR imaging had an overall sensitivity of 91% and a specificity of 71% for active disease. The Crohn's disease activity index had a sensitivity of 92% and a specificity of 28%. On a per segment basis, MR imaging had a sensitivity of 59% and a specificity of 93%. Bowel wall thickening of greater than 4 mm, bowel wall enhancement (ratio of signal intensity of abnormal to normal bowel > 1.3:1), and increased mesenteric vascularity were useful in identifying active disease. A layered enhancement pattern after the IV administration of gadolinium was highly specific for active inflammation. MR imaging is useful in assessing the activity of Crohn's disease and may be helpful when clinical scoring is equivocal.
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            MR enteroclysis: technical considerations and clinical applications.

            Magnetic resonance enteroclysis (MRE) is an emerging technique for the evaluation of small bowel abnormalities. Adequate luminal distention, achieved by the administration of iso-osmotic water solution through a nasojejunal catheter, in combination with ultrafast sequences, such as single-shot turbo spin echo, true fast imaging with steady precession, half-Fourier acquired single-shot turbo spin echo, and 3D fast low-angle shot, results in excellent anatomic demonstration of the small bowel. Magnetic resonance fluoroscopy can be performed during MRE examination and might be useful in studying low-grade stenosis or motility-related disorders. Magnetic resonance enteroclysis is very promising in detecting the number and extent of involved small bowel segments in patients with Crohn's disease, and in disclosing lumen narrowing and extramural manifestations and complications of the disease. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.
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              MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis.

              The aim of the study was to evaluate the additional findings of MRI following small bowel enteroclysis and to compare the efficacy of negative and positive intraluminal contrast agents. Fifty patients with inflammatory or tumorous small bowel disease were investigated by small bowel enteroclysis and consecutive MRI using breathhold protocol (T1-weighted fast low-angle shot, T2-weighted turbo spin echo). Patients were randomly assigned to either receiving a positive oral (Magnevist, Schering, Berlin, Germany) or a negative oral MR contrast media (Abdoscan, Nycomed, Oslo, Norway). The pattern of contrast distribution, the contrast effect, presence of artifacts, as well as bowel wall and extraluminal changes, were determined and compared between the contrast type using Fischer's exact test. Sensitivity, specificity, and diagnostic accuracy for MRI and enteroclysis were calculated. Twenty-seven patients had clinically proven Crohn's disease and two patients surgically proven small bowel tumours. Magnetic resonance imaging had important additional findings as abscesses and fistulae in 20 patients. Surgically compared sensitivities were 100 and 0% for MRI and enteroclysis, for the detection of abscesses, and 83.3 and 17 % for the diagnosis of fistulae, respectively. Bowel wall thickening was more reliably detected with use of positive oral contrast media without intravenous enhancement (p < 0.001), whereas postcontrast negative oral contrast media allow for a superior detection (p < 0.001). T2-weighted sequences were necessary with use of negative oral contrast media, because loop abscesses may be masked. Magnetic resonance imaging should be performed in all patients with suspicion of extraintestinal complications, because the complications are more reliably detected by MRI. Negative oral contrast media show advantages with the use of intravenous contrast but can mask loop abscesses using only T1-weighted imaging.
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                Author and article information

                Journal
                Saudi J Gastroenterol
                SJG
                Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association
                Medknow Publications (India )
                1319-3767
                1998-4049
                October 2009
                : 15
                : 4
                : 253-257
                Affiliations
                Department of Radiology, Haydarpasa Numune Education and Research Hospital, İstanbul, Turkey
                [1 ]Department of Gastroenterology, Haydarpasa Numune Education and Research Hospital, İstanbul, Turkey
                Author notes
                Address for correspondence: Dr. Burcu Narin, Department of Radiology, Haydarpasa Numune Education and Research Hospital, İstanbul, Turkey. E-mail: burcu_narin@ 123456yahoo.com
                Article
                SJG-15-253
                10.4103/1319-3767.56104
                2981842
                19794271
                54052493-3783-466d-8572-ae51cc7fded1
                © Saudi Journal of Gastroenterology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 January 2009
                : 04 August 2009
                Categories
                Original Article

                Gastroenterology & Hepatology
                crohn,gadolinium,mr enteroclysis,colonoscopy,small bowel
                Gastroenterology & Hepatology
                crohn, gadolinium, mr enteroclysis, colonoscopy, small bowel

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