What are the guidelines for use of CTE and MRE in patients with small bowel Crohn disease?

Updated: Jul 26, 2019
  • Author: Leyla J Ghazi, MD; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Answer

In 2017, an expert panel, which included contributors from the Society of Abdominal Radiology Crohn’s Disease–Focused Panel, the Society of Pediatric Radiology, and the American Gastroenterological Association, issued the following guidelines on the use of computed tomography enterography (CTE) and magnetic resonance enterography (MRE) in patients with small bowel Crohn disease [150, 151] :

  • The number of involved bowel segments and their location, as well as the length and degree of upstream dilatation of Crohn strictures, should be reported by radiologists to help gastroenterologists and surgeons determine the best therapeutic plan.
  • Radiologists should state if mural inflammation is present when describing areas with stricture or penetrating disease.
  • Cross-sectional enterography should be performed at Crohn disease diagnosis.
  • Consider cross-sectional enterography for disease monitoring in patients with small bowel disease or penetrating complications.
  • While a dedicated pelvic magnetic resonance (MR) study is needed in patients with perianal disease, all CTEs and MREs should also include imaging of the anus.
  • Radiologists should comment on and describe intramural T2 hyperintensity, restricted diffusion, perienteric stranding, wall thickness, and mural ulcerations seen on imaging, because they typically correlate with disease severity.
  • MRE is preferred over CTE to estimate response to medical treatment in patients with asymptomatic disease.
  • Noncontrast MRE with T2-weighted and diffusion-weighted imaging is an “acceptable alternative” when intravenous contrast agents cannot be used.
  • Radiologists should evaluate CTE and MRE examinations for signs of mesenteric venous thrombosis, occlusions, or small bowel varices.

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