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P271 Role of magnetic resonance in imaging of mesentery in Crohn’s disease

A. Surowiecka-Pastewka*1,2, M. Frączek3,4, J. Walecki3,4, M. Durlik1,2

1CSK Mswia, Department of Gastroenterological Surgery and Transplantation, Warsaw, Poland, 2Mossakowski Medical Research Centre of the Polish Academy of Sciences, Department of Surgical Research and Transplantology, Warsaw, Poland, 3CSK MSWiA, Diagnostic Radiology Department, Warsaw, Poland, 4Medical Centre of Postgraduate Education, Warsaw, Poland

Background

Mesenteric adipocites, fat tissue and mesenteric lymph nodes (MLN) are believed to be the origins of the intestinal wall destruction. MRI is the best imaging modality for assessment of the mesentery due to its high tissue contrast resolution. Moreover, MRI utilises no ionised radiation. There are no uniform imaging criteria for assessment the activity of CD in MRI. The aim of the study was to evaluate the role of MRI in assessment of disease activity based on evaluation of mesentery.

Methods

The study was approved by The Bioethical Committee. A group of 30 adults with diagnosed CD was enrolled into the study. All patients had MRI performed on 3T scanner in enteroclysis protocol with the application of spasmolytic agents and gadolinium intravenous contrast medium. MRI images where reviewed for following radiologic signs of mesenteric abnormalities: comb sign, mesenteric lymph node (MLN) size and number, MLN enhancement, mesenteric fat creeping, mesenteric oedema. The results were compared with clinical data and CD course severity, based on age, sex, CD duration, conservative and surgical treatment, CDAI and SES-CD. Mann–Whitney U test, multivariate regression and Spearman correlation of imaging and clinical findings (a type of treatment, CDAI, SES-CD and simplified Geboes index) have been performed on Statistica 13.

Results

The mean age of the analysed group was 34 years. The mean calprotectin level on the time of MRI examination was 364 mg/dl. More than half of the patient suffered from chronic abdominal pain. Thirty-one per cent underwent anti-TNF therapy, and 15% were on steroids administration on the time of MRI. In SES-CD score 29% was in remission, 23% had mild CD, 47% moderate or severe CD course. Forty per cent underwent surgical treatment before MRI. The comb sign was associated with higher SES-CD score, as well as with increased MLN enhancement (p < 0.05). Mesentery of patients after biological treatment and on steroids was characterised by higher multiplicity of MLN (over 10 and 5, respectively) (p < 0.05) and vivid contrast enhancement of MLN (p < 0.01).

Conclusion

Assessment of mesentery in MRI can serve as an independent tool in CD activity evaluation. Comb sign, MLN enhancement and number were related to the severity of CD.