Magnetic resonance imaging in diagnosis and follow-up of Crohn's disease - Is conventional enteroclysis still necessary?

A non-invasive diagnostic modality for differential diagnosis and detection of complications in inflammatory bowel disease (IBD) is desirable as alternative to invasive and troublesome endoscopy and conventional radiological methods. Methods: 51 patients suspicious of inflammatory bowel disease (bloody diarrhoea, symptoms of stenosis, abdominal pain) were investigated consecutively according to a standardised protocol by magnetic resonance tomography (MRI). Also, endoscopy was performed dependent on clinical presentation. MRI findings were compared to clinical follow-up, percutaneous ultrasonography (US), endopscopy, and surgical findings. Results: MRI confirmed diagnosis of Crohn's disease (CD) in more than 90% of cases. In case of distinct lesions, all of these were detected by MRI in the small bowel and colon. Discreet inflammatory lesions were not seen regularly. Numerous findings in endoscopically inaccessible bowel segments were described by MRI, extraintestinal lesions (conglomerate, abscess, fistulae) were detected accurately. Altogether, MRI was superior to abdominal ultrasonography. Conclusion: In patients with distinct inflammatory bowel disease, and in detection of complications (abscess, fistulae), MRI appears as versatile, non-invasive and accurate diagnostic instrument with therapeutical consequence. Endoscopy remains method of first choice for detection of discreet lesions and for histopathological diagnosis.