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25-02-2010 | Gastroenterology | Article

Incidental findings frequent with MRI for Crohn's disease

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MedWire News: Magnetic resonance imaging (MRI) enterography in patients with known or suspected Crohn's disease commonly reveals incidental findings, research shows.

These incidental findings frequently lead to additional examinations, but reveal important disease in only a minority of patients, according to researchers.

"A substantial number of patients experienced unnecessary morbidity because of the additional examinations of benign or normal conditions," writes Michael Jensen (Lillebaelt Hospital, Vejle, Denmark) and colleagues in the World Journal of Gastroenterology.

MRI is increasingly used for the assessment of small bowel Crohn's disease, and has high diagnostic accuracy and reproducibility. One of the advantages is that MRI allows clinicians to see disease beyond the intestinal wall, such as in abcesses and fistulas.

Incidental findings not related to Crohn's disease, however, can lead to additional examinations, or even surgery of benign lesions, resulting in increased morbidity.

In this study, Jensen and colleagues sought to determine the frequency and clinical importance of incidental findings detected by MRI enterography.

Extra-intestinal incidental findings were defined as lesions outside the small intestine, and not suspected at the time of referral, and not related to inflammatory bowel disease. Extra-intestinal incidental findings were identified in 25% of 283 patients, and were previously unknown in 20%.These findings led to 12 additional interventions in nine (3.2%) patients, and these investigations confirmed abnormal lesions in five (1.8%) patients.

The researchers report that two (0.7%) patients benefited from the additional exams, one who underwent surgery for an aortic aneurysm and another with prostate cancer, but led to unnecessary examinations in nine other patients.

In addition, incidental colon findings were reported in 16 (5.7%) patients. Twelve of these patients had minor or irrelevant abnormalities and four patients underwent further investigation that revealed no pathology.

Although the incidental findings are common in patients with known and suspected Crohn's disease undergoing MRI, "the detection rate of important incidental lesions not related to Crohn's disease was too low to be an argument in itself for performing MRI enterography in this group of patients."

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