Abdominal MRI without enteral contrast accurately detects intestinal fibrostenosis in patients with inflammatory bowel disease

Jeremy G. Fisher, Bobby T Kalb, Diego R Martin, Tanvi Dhere, Sebastian D. Perez, Jahnavi K. Srinivasan

Research output: Contribution to journalArticle

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Abstract

Patients with inflammatory bowel disease (IBD) presenting for surgical evaluation require thorough small bowel surveillance as it improves accuracy of diagnosis (ulcerative colitis versus Crohn's) and differentiates those who may respond to nonoperative therapy, preserving bowel length. MRI has not been validated conclusively against histopathology in IBD. Most protocols require enteral contrast. This study aimed to 1) evaluate the accuracy of MRI for inflammation, fibrosis, and extraluminal complications and 2) compare MRI without enteral contrast to standard magnetic resonance enterography. Adults with Crohn's disease or ulcerative colitis who underwent abdominal MRI and surgery were retrospectively reviewed. Of 65 patients evaluated, 55 met inclusion criteria. Overall sensitivity and specificity of MRI for disease involvement localized by segment were 93 per cent (95% confidence interval 5 89.4-95.0) and 95 per cent (95% confidence interval 5 92.3-97.0), respectively (positive predictive value was 86%, negative predictive value was 98%). Sensitivity and specificity between MRI with and without oral and rectal contrast were similar (96% vs 91% and 99% vs 94%, P > 0.10). As were positive predictive value and negative predictive value (85% vs 96%, P 5 0.16; 97% vs 99%, P 5 0.42). Magnetic resonance is highly sensitive and specific for localized disease involvement and extraluminal abdominal sequelae of IBD. It accurately differentiates patients who have chronic transmural (fibrotic) disease and thus may require an operation from those with acute inflammation, whose symptoms may improve with aggressive medical therapy alone. MRI without contrast had comparable diagnostic yield to standard magnetic resonance enterography.

Original languageEnglish (US)
Pages (from-to)1118-1124
Number of pages7
JournalAmerican Surgeon
Volume81
Issue number11
StatePublished - Nov 1 2015
Externally publishedYes

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Inflammatory Bowel Diseases
Small Intestine
Magnetic Resonance Spectroscopy
Ulcerative Colitis
Confidence Intervals
Inflammation
Sensitivity and Specificity
Crohn Disease
Fibrosis
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Abdominal MRI without enteral contrast accurately detects intestinal fibrostenosis in patients with inflammatory bowel disease. / Fisher, Jeremy G.; Kalb, Bobby T; Martin, Diego R; Dhere, Tanvi; Perez, Sebastian D.; Srinivasan, Jahnavi K.

In: American Surgeon, Vol. 81, No. 11, 01.11.2015, p. 1118-1124.

Research output: Contribution to journalArticle

Fisher, Jeremy G. ; Kalb, Bobby T ; Martin, Diego R ; Dhere, Tanvi ; Perez, Sebastian D. ; Srinivasan, Jahnavi K. / Abdominal MRI without enteral contrast accurately detects intestinal fibrostenosis in patients with inflammatory bowel disease. In: American Surgeon. 2015 ; Vol. 81, No. 11. pp. 1118-1124.
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abstract = "Patients with inflammatory bowel disease (IBD) presenting for surgical evaluation require thorough small bowel surveillance as it improves accuracy of diagnosis (ulcerative colitis versus Crohn's) and differentiates those who may respond to nonoperative therapy, preserving bowel length. MRI has not been validated conclusively against histopathology in IBD. Most protocols require enteral contrast. This study aimed to 1) evaluate the accuracy of MRI for inflammation, fibrosis, and extraluminal complications and 2) compare MRI without enteral contrast to standard magnetic resonance enterography. Adults with Crohn's disease or ulcerative colitis who underwent abdominal MRI and surgery were retrospectively reviewed. Of 65 patients evaluated, 55 met inclusion criteria. Overall sensitivity and specificity of MRI for disease involvement localized by segment were 93 per cent (95{\%} confidence interval 5 89.4-95.0) and 95 per cent (95{\%} confidence interval 5 92.3-97.0), respectively (positive predictive value was 86{\%}, negative predictive value was 98{\%}). Sensitivity and specificity between MRI with and without oral and rectal contrast were similar (96{\%} vs 91{\%} and 99{\%} vs 94{\%}, P > 0.10). As were positive predictive value and negative predictive value (85{\%} vs 96{\%}, P 5 0.16; 97{\%} vs 99{\%}, P 5 0.42). Magnetic resonance is highly sensitive and specific for localized disease involvement and extraluminal abdominal sequelae of IBD. It accurately differentiates patients who have chronic transmural (fibrotic) disease and thus may require an operation from those with acute inflammation, whose symptoms may improve with aggressive medical therapy alone. MRI without contrast had comparable diagnostic yield to standard magnetic resonance enterography.",
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