EJR: MRE provides viable option for Crohns evaluation
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Incidence of inflammatory bowel disease has spiked 31 percent in the U.S. since 1991 and presents a challenging diagnostic situation for gastroenterologists, according to David J. Grand, MD, director of the body MRI program at Rhode Island Hospital in Providence, R.I., and colleagues.
CT enterography (CTE) has served as a primary method for imaging evaluation of Crohn’s disease; however, ionizing radiation presents a concern as patients often present while young and require multiple studies throughout their lives.
MRE has emerged as an alternative with excellent efficacy. But the standard protocol uses anti-peristaltic agents to minimize small bowel motion. “While a thoughtful approach to maximizing image quality, the need for this added complexity and expense has never been proven,” wrote Grand and colleagues.
The researchers sought to compare MRE without anti-peristaltic agents to CTE performed on the same day in 25 patients who presented for Crohn’s disease evaluation (mean age, 42 years; range 18 to 78 years).
Two abdominal imagers, blinded to clinical history, independently reviewed all images and rated them on a 10-point scale for exam quality, diagnostic confidence and presence of Crohn’s disease.
Both readers agreed that CTE provided excellent image quality. The readers rated MRE image quality lower at a statistically significant level. However, diagnostic confidence held steady at 9.0/10.0 for CTE and MRE for Reader One, while dropping from 9.2/10.0 for CTE to 8.2/10 for MRE for Reader Two.
There was substantial agreement between both readers for the presence or absence of Crohn’s disease using CTE. Agreement dipped, but remained substantial, for MRE, according to the authors.
“The decreased perceived image quality of MRE did not affect diagnosis of the presence or absence of Crohn’s disease,” offered Grand et al.
The researchers acknowledged the lack of pathologic confirmation of results as a limitation of the study, but pointed out that their purpose was not to prove the efficacy of MRE.
Grand and colleagues explained that MRE delivers advantages over CTE, including exam redundancy. That is, MRE enables users to evaluate each bowel segment at multiple time points. They concluded, “Our study suggests a simplified protocol for MRE which maintains diagnostic yield while decreasing complexity and expense.”