Magnetic Resonance Enterography for Crohn's Disease: What the Surgeon Can Take Home
Anna Pozza3, Marco Scarpa*1, Carmelo Lacognata2, Francesco Corbetti2, Claudia Mescoli4, Cesare Ruffolo5, Mauro G. Frego3, Massimo Rugge4, Romeo Bardini3, Imerio Angriman3
1Department of Oncological Surgery, Venetian Oncology Institute (IOV-IRCCS), Padova, Italy; 2Dept. of Radiology, Azienda Ospedaliera di Padova, Padova, Italy; 3Dept. of Surgical and Gastroenterological Sciences, University of Padova, Padova, Italy; 4Dept. of Medical Diagnostic Sciences & Special Therapies (Pathology section), University of Padova, Padova, Italy; 5Dept. of Surgery (IV unit), Regional Hospital “Ca’ Foncello”, Treviso, Italy
Background
Crohn’s disease (CD) is a life long, chronic, relapsing condition that involves the entire digestive tract requiring often morphological assessment. MR enterography (MRE) offers advantages of not using ionizing radiation and yielding intra luminal and intra abdominal informations. The aim of our study was to identify how MRE can be useful in planning 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 kappa agreement test, sensitivity and sensibility, uni/multivariate logistic regression and non parametric statistics were performed.
Results
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 fistulas 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 proximal 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. Proximal bowel dilatation can suggest the possibility to perform bowel sparing surgery such as stricturoplasty.
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