P123. Impact of magnetic resonance enterography on decision-making in small-bowel Crohn's disease
P. Figueiredo1, C. Cardoso2, M. Ramalho3, M.J. Barata3, J. Freitas1
1Hospital Garcia De Orta, Department of Gastroenterology, Almada, Portugal; 2Hospital São Bernardo, Department of Gastroenterology, Setúbal, Portugal; 3Hospital Garcia De Orta, Department of Radiology, Almada, Portugal
Background: Small-bowel involvement in Crohn's disease (CD) is a major factor in morbidity and prognosis. Magnetic resonance enterography (MRE) has an established role in the study of the small-bowel as it allows a simultaneous visualization of luminal, mural and extra-intestinal disease extension, without exposing the patient to ionizing radiation. Our aim was to assess the impact of MRE on the management of CD patients in clinical practice.
Methods: We reviewed the clinical data and MRE findings in consecutive MREs performed in CD patients from January 2008 to June 2011 at a single tertiary care centre. We looked for symptoms, clinical indication for MRE, major imaging findings (i.e. disease activity, complications or combination of these). To evaluate the impact of MRE, we searched for patients in whom MRE led to changes in medical treatment or surgical management.
Results: Sixty-one patients with 76 MRE were included in the study (25 males, 36 females; mean age 36.6±15.3 years. Patients underwent MRE 7.9 years (±8.3 years) after CD diagnosis, with MRE performed in the first year of disease in 13 patients. Fifteen (24.6%) patients had previous CD-related bowel surgery. Forty-one (53.9%) patients had abdominal pain; 28 (36.8%) patients had diarrhea; and 26 (34.2%) patients had a variety of other symptoms or findings (vomiting, fever, abdominal mass). Twenty (26.3%) patients were asymptomatic.
The purpose of the MRE was to identify small-bowel involvement in 36 (48.6%) cases, to re-evaluate previously known small bowel lesions in 16 (21.6%) cases or to confirm suspected complications of CD in 22 (29.7%).
Absence of active disease was found in 13 (17.6%) cases. Disease activity/inflammation was found in 33 (44.6%) cases and disease activity with CD complication (fistula, stenosis, abscess) in 26 (35.1%) cases. Two (2.7%) of the cases were found to have CD complication without disease activity.
In 29 (42%) cases MRE led to a modification in pharmacological approach and in 8 (11.6%) cases it led to a surgical decision. MRE did not change management in 27 (39.1%) of the cases and in 5 (6.6%) cases, further diagnosis work-up was considered.
Conclusions: Our study found that MRE in CD patients presented important information, concerning disease activity and/or complication of disease involving the small-bowel, which played a decisive role in clinical decision making, leading to a therapeutic change or influencing surgical decisions in more than half (n = 37; 53.6%) of patients.