Magnetic resonance enterography useful for Crohn’s disease management
MedWire News: Magnetic resonance enterography (MRE) helps clinicians to identify active Crohn’s disease (CD) and its chronic complications, show study results.
Better identification with MRE will allow clinicians to enhance their ability to implement new medical or surgical treatment for CD patients if required, say Evangelos Messaris (Brown University, Providence, Rhode Island, USA) and team.
MRE has been developed as an alternative to computed tomographic enterography in order to minimize radiation exposure, as CD patients need multiple imaging over their lifetime,
In this study, the researchers evaluated the efficacy of MRE and its influence on CD management in 120 patients with either a history of or a high suspicion for having CD who were experiencing new symptoms.
MRE showed evidence of active CD in 57.5% of patients, chronic disease changes without active inflammation such as stricture, fistula, or abscess in 12.5%, and no evidence of CD in 30% of patients.
Following MRE, 53% of the patients had additional treatment for active inflammation and 16% underwent an operation to treat complicated CD or because of medical intractability, while 31% had no change in therapy.
Intra-operative findings confirmed the MRE diagnosis in all the patients who underwent surgery.
The researchers found that the MRE score, calculated by assigning numeric values to agreed indicators of active inflammation, was an independent predictor for surgical or medical intervention and a 1-unit increase in score amplified the odds of intervention 1.5 fold in patients with CD.
Mean MRE score out of a maximum of 15 was 1.6, 5.8, and 8.0 in patients who had no treatment change, underwent surgery, and had their drug treatment changed, respectively.
“Patients with a history of CD and onset of new gastrointestinal symptoms remain difficult to diagnose and treat,” say Messaris et al in the Archives of Surgery.
They suggest that their results indicate that “larger prospective studies to investigate whether the results of MRE can successfully alter the treatment algorithm of these patients and avoid unnecessary medical or surgical interventions” should be carried out.
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By Helen Albert