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P064. Magnetic resonance enterography for Crohn's disease: Surgical aspects

A. Pozza1, M. Scarpa2, C. Lacognata3, C. Mescoli1, C. Ruffolo4, M. Frego1, M. Rugge1, R. Bardini1, I. Angriman1

1University of Padova, Padova, Italy; 2Venetian Oncology Institute, Padova, Italy; 3Azienda Ospedaliera di Padova, Padova, Italy; 4Ospedale “Ca' Foncello”, Treviso, Italy

Aims: Crohn's disease (CD) is a life long, chronic, relapsing condition that involves the entire digestive tract requiring often morphological assessment. MRI enterography (MRE) offers advantages of to not use ionizing radiation and to yield intra luminal and intra abdominal informations. The aim of our study is to identify how MRE can be useful to plan surgical procedures.

Patients and Methods: In this retrospective study 35 patients who underwent MRE and then surgery for CD were enrolled from 2006 to 2010. MRE findings were compared to intraoperative findings. Histology of operative specimens, systemic inflammatory parameters (white blood cells count, platelets count, CRP, ESR, albumin, iron) and faecal lactoferrin were also evaluated. Cohen's k agreement test, sensitivity and sensibility, uni/multivariate logistic regression and non parametric statistics were performed.

Results: MRE described bowel stenosis in 26 patients (31.42%) and in 8 of them the stenosis was frankly fibrotic. Wall thickness was described in 26 patients and up-hill bowel dilatations the stenosis were observed in 24 patients. Up-hill bowel dilatation was graded as mild in 9 patients, moderate in 9 and severe in 6. MRI enterography reports described active inflammation within the bowel wall in 30 patients (31.42%) with overt abscess and fistulae in 15 patients and 15 patients, respectively. Fecal lactoferrin levels were directly correlated to the presence of abscess, the number of abscess, the presence of fistulae and of bowel wall inflammation as detected at MRE. CRP serum levels were correlated to the presence and the number of abscess, the presence and the number of fistulae and of bowel wall inflammation. MRE identified bowel stenosis with a sensitivity of 0.95 (95% CI 0.76–0.99), a specificity of 0.72 (95% CI 0.39–0.92). The concordance of MRE findings with intraoperative findings was high (Cohen's k = 0.72 (0.16). Abscesses were detected at MRE with a sensitivity of 0.92 (95% CI 0.62–0.99), a specificity of 0.90 (95% CI 0.69–0.98) with a Cohen's k = 0.82 (0.16). MRE identified bowel fistulae with a sensitivity of 0.71 (95% CI 0.42–0.90), a specificity of 0.76 (95% CI 0.52–0.90) and with Cohen's k = 0.47 (0.17). The grade of uphill bowel dilatation resulted to be a significant predictor of the possibility of using stricturoplasty instead of/associated to bowel resection either at univariate or at multivariate analysis

Conclusion: Our study confirmed that MRE findings correlate significantly with disease activity. Once decided that the patient should undergo surgical treatment MRE can provide the surgeon useful and adequate information about abscess, stenosis and fistulae. Detailed information about abscess could suggest percutaneous drainage that could ease the following surgery or avoid emergency laparotomy. Up-hill bowel dilatation can suggest the possibility to perform bowel sparing surgery such as stricturoplasty.