MRE Has Valuable Clinical Application for Patients With Known or Suspected Crohn's Disease

Emma Hitt, PhD

September 18, 2010

May 17, 2010 — Magnetic resonance enterography may help direct the management of patients with known or suspected Crohn's disease (CD), according to new research findings reported in today's issue of the Archives of Surgery.

"Magnetic resonance enterography has been proven to have high sensitivity and specificity in detecting CD in the gastrointestinal tract. [However,] there is very limited literature on the application of MRE findings in clinical practice for patients with CD," Evangelos Messaris, MD, PhD, and colleagues from the Warren Alpert Medical School at Brown University, Providence, Rhode Island, note. The researchers therefore sought to evaluate the effect of MRE on therapeutic decision-making in patients with CD at a tertiary care medical center.

A total of 120 patients with suspicious symptoms or a positive history of CD were included in the retrospective analysis. Patients underwent MRE during an 18-month period and were then managed, according to the findings, with either medical treatment or surgery.

The researchers found that MRE detected active disease in 57.5% of patients; 12.5% of the patients had chronic changes of CD without active signs of inflammation, such as stricture, fistula, or abscess; and 30% appeared to have no disease.

MRE resulted in no change in medical therapy in 31% of patients; however, 53% of the patients received additional medical management for inflammation, and 16% underwent surgery as a result of disease complications or lack of efficacy of medical treatment. Review of results for all surgical patients showed intraoperative findings to be consistent with the initial MRE diagnosis.

A scoring system associated with increasing indicators of active inflammation was used to classify patients' MRE findings. The mean MRE score was 1.6 for patients who had no change in their treatment plans, 5.8 for patients who underwent surgery, and 8 for patients who had their drug regimen changed (P < .001). In addition, the MRE score independently correlated with need for intervention (P = .001).

The researchers also found that during a 3-month follow-up, no changes were made in the treatment protocol that was initiated after the MRE.

"In patients with known CD and onset of new symptoms, MRE can add significant information to the clinical evaluation to determine if any therapy is needed and if it is, whether it should be surgical or medical," the authors conclude.

The authors have disclosed no relevant financial relationships.

Arch Surg. 2010;145:471-475.

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