Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study

• Published in: Gut Vol. 54; no. 2; pp. 250 - 256
• Main Authors: Schreyer, A G, Rath, H C, Kikinis, R, Völk, M, Schölmerich, J, Feuerbach, S, Rogler, G, Seitz, J, Herfarth, H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Society of Gastroenterology 01.02.2005; BMJ; BMJ Publishing Group LTD; Copyright 2005 by Gut
• Subjects: Adult; Aged; Biological and medical sciences; Colitis, Ulcerative - diagnosis; Colonoscopy; computed tomography; Contrast Media; Crohn Disease - diagnosis; Crohn’s disease; Digestive system. Abdomen; Endoscopy; Feasibility Studies; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; IBD; Inflammatory Bowel Disease; Inflammatory Bowel Diseases - diagnosis; Investigative techniques, diagnostic techniques (general aspects); magnetic resonance; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; MRI; Other diseases. Semiology; Prospective Studies; Sensitivity and Specificity; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; ulcerative colitis; virtual endoscopy; volume rendering; Performance evaluation; Human; Digestive system; Critically ill; Inflammation; Method; Medical screening; Nuclear magnetic resonance imaging; Virtual endoscopy; Inflammatory disease; Image quality; Crohn disease; Sensitivity; Colonoscopy; Digestive diseases; Medical imagery; Intestinal disease; Feasibility; Colon; Diagnosis; Endoscopy; Comparative study; Polyp; Ulcerative colitis
• ISSN: 0017-5749; 1468-3288; 1458-3288
• DOI: 10.1136/gut.2003.037390

Aim: Magnetic resonance imaging (MRI) based colonography represents a new imaging tool which has mainly been investigated for polyp screening. To evaluate this approach for patients with inflammatory bowel disease (IBD), we compared MRI based colonography with conventional colonoscopy for assessing the presence and extent of colonic inflammation. Patients and methods: In 22 consecutive patients with suspected or known IBD, MRI colonography was performed immediately before conventional colonoscopy. After bowel cleansing, a T1 positive contrast agent was applied rectally. In addition to T2 weighted sequences, T1 weighted two dimensional and three dimensional Flash acquisitions as well as volume rendered virtual endoscopy were performed. All images were evaluated with regard to typical MRI features of inflammation. The results were compared with colonoscopy findings. Results: Distension and image quality was assessed as good to fair in 97.4% of all colonic segments. Only four of 154 segments were considered non-diagnostic. With colonoscopy serving as the gold standard, the sensitivity for correctly identifying inflammation on a per segment analysis of the colon was 31.6% for Crohn’s disease (CD) and 58.8% for ulcerative colitis (UC). In CD, in most cases mild inflammation was not diagnosed by MRI while in UC even severe inflammation was not always depicted by MRI. Virtual endoscopy did not add any relevant information. Conclusion: MRI based colonography is not suitable for adequately assessing the extent of colonic inflammation in patients with IBD. Only severe colonic inflammation in patients with CD can be sufficiently visualised.