90th Annual Meeting Abstracts
The Role of Magnetic Resonance Enterography in the Management of Crohn’s Disease.
*Evangelos Messaris, MD, Ph.D1, *Nicholas Chandolias, MD1, *David Grand, MD2, Victor Pricolo, MD1
1Dept. of Surgery, Alpert Medical School of Brown University, Providence, RI;2Dept. of Radiology, RIH, Providence, RI
Objective. To assess the impact of Magnetic Resonance Enterography (MRE) in therapeutic decision-making for patients with Crohn’s Disease.
Design. Retrospective cohort study.
Setting. Tertiary care academic medical center.
Patients. Four hundred and fifty-seven consecutive patients underwent MRE over 18 months at our institution. Our study focused on one hundred and twenty patients (47 men, 73 women) who had either a history or high suspicion for Crohn’s disease with onset of new symptoms. Patients’ age ranged from 10 to 80 years (mean = 37.1±1.4). All Crohn’s patients were classified according to the Montreal system (age, location of disease, phenotype).
Interventions. MRE, medical versus surgical therapy.
Main Outcome Measures. Changes in management prompted by MRE findings.
Results. MRE demonstrated active Crohn’s disease in 57.5% of patients, no active disease but a complication of it (e.g. stricture, fistula, or abscess) in 15% of cases and no disease in 30% of cases. There was no association between age or disease phenotype with presence of active disease on MRE (p<0.05). Patients with history of colorectal and perianal disease were more likely to have active disease on MRE (25%) than patients with ileo-cecal disease (7%) (p=0.009). On the basis of MRE findings, thirty-seven patients (31%) had no change in medical therapy, sixty-four (53%) had additional medical management for uncomplicated disease and nineteen (16%) underwent an operation for complicated Crohn’s or medical intractability. In all surgical patients the intraoperative findings were consistent with the MRE diagnosis.
Conclusions. MRE shows promising ability to characterize presence of active Crohn’s disease and its complications. MRE is a useful adjunct in the management algorithm of patients with Crohn’s disease.