Johannes Sailer MD, Presenter: Nothing to Disclose

Philipp L. Peloschek MD, Abstract Co-Author: Nothing to Disclose

Walter Reinisch MD, Abstract Co-Author: Nothing to Disclose

Harald Vogelsang, Abstract Co-Author: Nothing to Disclose

Karl Turetschek MD, Abstract Co-Author: Nothing to Disclose

Wolfgang Schima MD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic accuracy of MR enteroclysis compared to ileoendoscopy in patients with Crohn´s disease recurrence after ileocolic resection and to establish a new MR score to differentiate between low- and high-grade lesions.

MR enteroclysis (1.5 T) and endoscopy were performed in 30 patients with suspected anastomotic recurrence of Crohn´s disease after ileocolic resection. Findings were evaluated by three radiologists, who used an MR score based on overall image quality, small bowel distension, contrast enhancement, and mural and extramural changes of the anastomosis and the neoterminal ileum. A four-point scale was devised for findings as follows: MR 0 (no pathologic changes); MR 1 (minimal mucosal changes); MR 2 (diffuse aphtoid ileitis, i.e., moderate recurrence); and MR 3 (severe recurrence with trans- and extramural changes).

MR enteroclysis was performed successfully all patients. MR image quality was rated good to excellent in those patients. The mean overall image quality was rated as 1.7 (kappa 0.78). Comparing the MR and the Rutgeerts score, the mean observer agreement for findings in the neoterminal ileum was 85.2% (kappa 0.79), with 63% (kappa 0.49) for the anastomosis ,and 77.8% (kappa 0.67) for the total score rating . When comparing only scores of below and above MR 2 as the threshold indicative of the necessity of medical treatment, there was a total agreement of 95.1% (kappa 0.84).

Findings at MR enteroclysis in patients with Crohn’s disease are valuable for scoring recurrence after ileocolic resection. The MR score shows high agreement with the approved endoscopic Rutgeerts score. It allows differentiation between low-grade and intermediate inflammatory recurrence and is therefore helpful for stratification of therapy.

MR enteroclysis allows for differentiation of low- and high grade Crohn´s disease recurrence and provides information in the decision about whether medical or surgical therapy is indicated.

Sailer, J, Peloschek, P, Reinisch, W, Vogelsang, H, Turetschek, K, Schima, W, Anastomotic Recurrence of Crohn´s Disease after Ileocolic Resection: Comparison of MR Enteroclysis with Endoscopy.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5010857.html