Abstract Archives of the RSNA, 2013
Pre-obstructive Changes in Small Bowel Motility in Stricturing Crohn’s Disease Appear Reversible on Investigation with MRE
Scientific Formal (Paper) Presentations
Presented on December 5, 2013
Presented as part of SSQ06: ISP: Gastrointestinal (Crohns Disease)
Alex Menys, Presenter: Nothing to Disclose
Emma Helbren MBBCh, FRCR, Abstract Co-Author: Nothing to Disclose
Jesica Makanyanga, Abstract Co-Author: Nothing to Disclose
David Atkinson, Abstract Co-Author: Consultant, IXICO Limited
Alistair Forbes, Abstract Co-Author: Nothing to Disclose
Al Windsor, Abstract Co-Author: Nothing to Disclose
Steve Halligan MD, Abstract Co-Author: Nothing to Disclose
Stuart Andrew Taylor MBBS, Abstract Co-Author: Nothing to Disclose
To examine whether abnormal motility in pre-obstructive, dilated bowel is reversible.
21 patients with stricturing Crohn’s disease (9 Male, mean age 31) undergoing two 1.5T MR enterography (MRE) examinations (mean 14 months apart), were retrospectively identified. Multiple True FISP coronal motility sequences were acquired during 20 second breath holds (1 slice/0.8sec, TR 4ms, TE 1.7ms, slice thickness 10mm) to encompass the small bowel volume. On each of the two scans, a radiologist (5 years experience) placed an ROI in the dilated small bowel immediately upstream of the stricture, and in normal bowel remote from the diseased area. Using validated motility analysis software, measurements of small bowel motility (s.d of the pixel Jacobean determinant) and maximum bowel diameter were made. The percent change in bowel diameter and motility between the two scans was calculated for each ROI position and analysed using Spearman’s Rho.
The mean percentage change in pre-stricture bowel diameter and motility was -7% (range -70 to +65%) and -58% (range -625% to +89%) respectively. There was a negative correlation between the percentage change in diameter and motility (Spearman’s Rho coefficient -0.6, P = 0.007) ie as the diameter decreased, motility increased. There was no such correlation between diameter (mean change 3%, range -35% to 36%) and motility (mean change 11%, range -85% and 28%) in normal bowel (Spearman’s Rho 0.08, P = 0.94).
Motility changes in pre-stricture dilated bowel are fluid over time and different from normal bowel. As the bowel diameter decreases, motility increases and vice versa.
Medical management could be favourable over surgery in some instances. Loss of function in the small bowel is potentially reversible.
Pre-obstructive Changes in Small Bowel Motility in Stricturing Crohn’s Disease Appear Reversible on Investigation with MRE. Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13021809.html