|
|
Back to Annual Meeting Program
Value of Preoperative Magnetic Resonance Enterography to Predict Surgical Findings and to Guide Decisions in Crohn's Disease: a Prospective Study
Antonino Spinelli*1,2, Gionata Fiorino3, Piero Bazzi1,2, Cristiana Bonifacio4, Matteo Sacchi1, Sarah De Bastiani1, Andrea Gatti1, Alberto Malesci3,2, Luca Balzarini4, Laurent Peyrin-Biroulet5, Marco Montorsi1,2, Silvio Danese3
1Dept. of Surgery, Istituto Clinico Humanitas, Rozzano Milano, Italy; 2Dip. di Biotecnologie Mediche e Medicina Traslazionale, Università degli Studi di Milano, Milano, Italy; 3Dept. of Gastroenterology, Istituto Clinico Humanitas, Rozzano Milano, Italy; 4Dept. of Radiology, Istituto Clinico Humanitas, Rozzano Milano, Italy; 5Dept. of Hepato Gastroenterology, University of Nancy, Nancy, France
Background:
Surgery is still required for many patients with Crohn's disease (CD). Intraoperative detection of new lesions is common and may lead to a change in the planned approach (laparoscopic or open surgery) and strategy (type of resection or strictureplasty). Whether magnetic resonance enterography (MRE) can be used to optimize surgical planning and to guide decision-making in CD patients undergoing surgery is currently unclear.
Methods:
Seventy-five consecutive patients with complicated CD who were candidates for surgery were prospectively enrolled. MRE was performed according to a standardized protocol within 30 days before surgery. Two experienced radiologists blindly and independently assessed MRE images. Radiological findings were correlated with intraoperatively detected lesions. Analysis included MRE accuracy (per-segment and per-patient) and change in surgical strategy due to discordance with MRE findings.
Results:
Surgery was performed laparoscopically in 39/75 pts (52%; conversion to open surgery 6/39, 15%). Concordance rate among observers was excellent (kappa value > 0.8). MRE accuracy for inflammation, thickening, stenosis, abscess and fistula were all above 85% in per-patient analysis. In 68/75 cases (90.7%) both approach and strategy were correctly predicted by MRE. Conversely, in 7/75 cases (9.3%, 3 false positives: 2 enterocolic fistulas and 1 anastomotic stricture; and 4 false negatives: 3 enteric fistulas with colon, duodenum and bladder and 1 enteromesial abscess) surgical strategy (type of resection or strictureplasty, n=5) and/or surgical approach (conversion from laparoscopy to open surgery, n=2) changed due to discordance with MRE findings.
Conclusion:
Preoperative MRE correctly predicts surgical strategy in the majority of patients undergoing surgery for complicated CD. MRE is especially valuable before laparoscopic surgery, since unrecognized lesions may lead to conversion to open surgery.
Back to Annual Meeting Program
|
