Pediatric Gastroenterology, Hepatology & Nutrition

  • 제18권3호
  • /
  • Pages.149-159
  • /
  • 2015
  • /
  • 2234-8646(pISSN)
  • /
  • 2234-8840(eISSN)
대한소아소화기영양학회 (The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition)
권호 표지
DOI QR코드

DOI QR Code

Pediatric Magnetic Resonance Enterography: Focused on Crohn's Disease

  • Lee, So Mi (Department of Radiology, Seoul National University College of Medicine) ;
  • Kim, Woo Sun (Department of Radiology, Seoul National University College of Medicine) ;
  • Choi, Young Hun (Department of Radiology, Seoul National University College of Medicine)
  • 투고 : 2015.08.31
  • 심사 : 2015.09.08
  • 발행 : 2015.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Crohn's disease is a chronic idiopathic inflammatory disease of the intestines characterized by frequent relapse and remission. It often develops in children and adolescents, who are vulnerable to repeated exposure to ionizing radiations. Magnetic resonance enterography (MRE) is an increasingly important radiation-free imaging modality that is used to evaluate pediatric patients with Crohn's disease. MRE can evaluate extraluminal and extraintestinal abnormalities as well as the status of the bowel wall. In addition, MRE has an advantage in the evaluation of the small bowel involvement. MRE can be used for the initial diagnosis of Crohn's disease, and can aid in the assessment of disease activity and complications such as penetrating and fibrostenotic diseases. The aims of this article are to review the MRE technique for obtaining diagnostic and high-quality images and to discuss interpretations of imaging findings in patients with Crohn's disease.

키워드

참고문헌

  1. Leyendecker JR, Bloomfeld RS, DiSantis DJ, Waters GS, Mott R, Bechtold RE. MR enterography in the management of patients with Crohn disease. Radiographics 2009;29:1827-46. https://doi.org/10.1148/rg.296095510
  2. Day AS, Ledder O, Leach ST, Lemberg DA. Crohn's and colitis in children and adolescents. World J Gastroenterol 2012;18:5862-9. https://doi.org/10.3748/wjg.v18.i41.5862
  3. Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiographics 2010;30:367-84. https://doi.org/10.1148/rg.302095028
  4. Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis 2004;10:45-54. https://doi.org/10.1097/00054725-200401000-00008
  5. Desmond AN, O'Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, et al. Crohn's disease: factors associated with exposure to high levels of diagnostic radiation. Gut 2008;57:1524-9. https://doi.org/10.1136/gut.2008.151415
  6. Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 2009;251:751-61. https://doi.org/10.1148/radiol.2513081184
  7. Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008;247:64-79. https://doi.org/10.1148/radiol.2471070611
  8. Froehlich JM, Waldherr C, Stoupis C, Erturk SM, Patak MA. MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging. Eur Radiol 2010;20:1945-51. https://doi.org/10.1007/s00330-010-1759-x
  9. Del Vescovo R, Sansoni I, Caviglia R, Ribolsi M, Perrone G, Leoncini E, et al. Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn's disease. Abdom Imaging 2008;33:417-24. https://doi.org/10.1007/s00261-007-9267-4
  10. Oto A, Fan X, Mustafi D, Jansen SA, Karczmar GS, Rubin DT, et al. Quantitative analysis of dynamic contrast enhanced MRI for assessment of bowel inflammation in Crohn's disease pilot study. Acad Radiol 2009;16:1223-30. https://doi.org/10.1016/j.acra.2009.04.010
  11. Laghi A, Paolantonio P, Iafrate F, Altomari F, Miglio C, Passariello R. Oral contrast agents for magnetic resonance imaging of the bowel. Top Magn Reson Imaging 2002;13:389-96. https://doi.org/10.1097/00002142-200212000-00003
  12. Lauenstein TC, Schneemann H, Vogt FM, Herborn CU, Ruhm SG, Debatin JF. Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 2003;228:279-83. https://doi.org/10.1148/radiol.2281020161
  13. Young BM, Fletcher JG, Booya F, Paulsen S, Fidler J, Johnson CD, et al. Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr 2008;32:32-8. https://doi.org/10.1097/RCT.0b013e318061961d
  14. Kuehle CA, Ajaj W, Ladd SC, Massing S, Barkhausen J, Lauenstein TC. Hydro-MRI of the small bowel: effect of contrast volume, timing of contrast administration, and data acquisition on bowel distention. AJR Am J Roentgenol 2006;187:W375-85. https://doi.org/10.2214/AJR.05.1079
  15. Borthne AS, Abdelnoor M, Storaas T, Pierre-Jerome C, Klow NE. Osmolarity: a decisive parameter of bowel agents in intestinal magnetic resonance imaging. Eur Radiol 2006;16:1331-6. https://doi.org/10.1007/s00330-005-0063-7
  16. Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Dose optimization of mannitol solution for small bowel distension in MRI. J Magn Reson Imaging 2004;20:648-53. https://doi.org/10.1002/jmri.20166
  17. Ajaj W, Goyen M, Schneemann H, Kuehle C, Nuefer M, Ruehm SG, et al. Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention. Eur Radiol 2005;15:1400-6. https://doi.org/10.1007/s00330-005-2711-3
  18. Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension. Eur Radiol 2004;14:458-64. https://doi.org/10.1007/s00330-003-2177-0
  19. Absah I, Bruining DH, Matsumoto JM, Weisbrod AJ, Fletcher JG, Fidler JL, et al. MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image quality, and initial performance estimates. AJR Am J Roentgenol 2012; 199:W367-75. https://doi.org/10.2214/AJR.11.8363
  20. Mollard BJ, Smith EA, Lai ME, Phan T, Christensen RE, Dillman JR. MR enterography under the age of 10 years: a single institutional experience. Pediatr Radiol 2015. [Epub ahead of print]
  21. Mollard BJ, Smith EA, Dillman JR. Pediatric MR enterography: technique and approach to interpretationhow we do it. Radiology 2015;274:29-43. https://doi.org/10.1148/radiol.14122449
  22. Towbin AJ, Sullivan J, Denson LA, Wallihan DB, Podberesky DJ. CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics 2013;33:1843-60. https://doi.org/10.1148/rg.337105140
  23. Anupindi SA, Terreblanche O, Courtier J. Magnetic resonance enterography: inflammatory bowel disease and beyond. Magn Reson Imaging Clin N Am 2013; 21:731-50. https://doi.org/10.1016/j.mric.2013.05.002
  24. Darge K, Anupindi SA, Jaramillo D. MR imaging of the abdomen and pelvis in infants, children, and adolescents. Radiology 2011;261:12-29. https://doi.org/10.1148/radiol.11101922
  25. Sinha R, Rajiah P, Murphy P, Hawker P, Sanders S. Utility of high-resolution MR imaging in demonstrating transmural pathologic changes in Crohn disease. Radiographics 2009;29:1847-67. https://doi.org/10.1148/rg.296095503
  26. Dillman JR, Smith EA, Khalatbari S, Strouse PJ. I.v. glucagon use in pediatric MR enterography: effect on image quality, length of examination, and patient tolerance. AJR Am J Roentgenol 2013;201:185-9. https://doi.org/10.2214/AJR.12.9787
  27. Yacoub JH, Obara P, Oto A. Evolving role of MRI in Crohn's disease. J Magn Reson Imaging 2013;37:1277-89. https://doi.org/10.1002/jmri.24081
  28. Allen BC, Leyendecker JR. MR enterography for assessment and management of small bowel Crohn disease. Radiol Clin North Am 2014;52:799-810. https://doi.org/10.1016/j.rcl.2014.02.001
  29. Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics 2009;29:1811-25. https://doi.org/10.1148/rg.296095507
  30. Masselli G, Gualdi G. MR imaging of the small bowel. Radiology 2012;264:333-48. https://doi.org/10.1148/radiol.12111658
  31. Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P. MR enteroclysis: technical considerations and clinical applications. Eur Radiol 2002; 12:2651-8.
  32. Low RN, Sebrechts CP, Politoske DA, Bennett MT, Flores S, Snyder RJ, et al. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium- enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology 2002;222:652-60. https://doi.org/10.1148/radiol.2223010811
  33. Rottgen R, Grandke T, Grieser C, Lehmkuhl L, Hamm B, Ludemann L. Measurement of MRI enhancement kinetics for evaluation of inflammatory activity in Crohn's disease. Clin Imaging 2010;34:29-35. https://doi.org/10.1016/j.clinimag.2009.03.008
  34. Pupillo VA, Di Cesare E, Frieri G, Limbucci N, Tanga M, Masciocchi C. Assessment of inflammatory activity in Crohn's disease by means of dynamic contrast-enhanced MRI. Radiol Med 2007;112:798-809. https://doi.org/10.1007/s11547-007-0192-y
  35. Sinha R, Rajiah P, Ramachandran I, Sanders S, Murphy PD. Diffusion-weighted MR imaging of the gastrointestinal tract: technique, indications, and imaging findings. Radiographics 2013;33:655-76; discussion 676-80. https://doi.org/10.1148/rg.333125042
  36. Kiryu S, Dodanuki K, Takao H, Watanabe M, Inoue Y, Takazoe M, et al. Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn's disease. J Magn Reson Imaging 2009;29:880-6. https://doi.org/10.1002/jmri.21725
  37. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D. Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn's disease. Acad Radiol 2009;16:597-603. https://doi.org/10.1016/j.acra.2008.11.009
  38. Maglinte DD, Gourtsoyiannis N, Rex D, Howard TJ, Kelvin FM. Classification of small bowel Crohn's subtypes based on multimodality imaging. Radiol Clin North Am 2003;41:285-303. https://doi.org/10.1016/S0033-8389(02)00117-3
  39. Zappa M, Stefanescu C, Cazals-Hatem D, Bretagnol F, Deschamps L, Attar A, et al. Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn's disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 2011;17:984-93. https://doi.org/10.1002/ibd.21414
  40. Adler J, Punglia DR, Dillman JR, Polydorides AD, Dave M, Al-Hawary MM, et al. Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn's disease. Inflamm Bowel Dis 2012;18:849-56. https://doi.org/10.1002/ibd.21801
  41. Gee MS, Nimkin K, Hsu M, Israel EJ, Biller JA, Katz AJ, et al. Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol 2011;197: 224-31. https://doi.org/10.2214/AJR.10.5970
  42. Rimola J, Rodriguez S, García-Bosch O, Ordás I, Ayala E, Aceituno M, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut 2009;58:1113-20. https://doi.org/10.1136/gut.2008.167957
  43. Punwani S, Rodriguez-Justo M, Bainbridge A, Greenhalgh R, De Vita E, Bloom S, et al. Mural inflammation in Crohn disease: location-matched histologic validation of MR imaging features. Radiology 2009;252: 712-20. https://doi.org/10.1148/radiol.2523082167
  44. Sempere GA, Martinez Sanjuan V, Medina Chulia E, Benages A, Tome Toyosato A, Canelles P, et al. MRI evaluation of inflammatory activity in Crohn's disease. AJR Am J Roentgenol 2005;184:1829-35. https://doi.org/10.2214/ajr.184.6.01841829
  45. Oto A, Kayhan A, Williams JT, Fan X, Yun L, Arkani S, et al. Active Crohn's disease in the small bowel: evaluation by diffusion weighted imaging and quantitative dynamic contrast enhanced MR imaging. J Magn Reson Imaging 2011;33:615-24. https://doi.org/10.1002/jmri.22435
  46. Koh DM, Miao Y, Chinn RJ, Amin Z, Zeegen R, Westaby D, et al. MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 2001;177:1325-32. https://doi.org/10.2214/ajr.177.6.1771325
  47. Gourtsoyianni S, Papanikolaou N, Amanakis E, Bourikas L, Roussomoustakaki M, Grammatikakis J, et al. Crohn's disease lymphadenopathy: MR imaging findings. Eur J Radiol 2009;69:425-8. https://doi.org/10.1016/j.ejrad.2008.11.009
  48. Pariente B, Cosnes J, Danese S, Sandborn WJ, Lewin M, Fletcher JG, et al. Development of the Crohn's disease digestive damage score, the Lémann score. Inflamm Bowel Dis 2011;17:1415-22. https://doi.org/10.1002/ibd.21506
  49. Sinha R, Verma R, Verma S, Rajesh A. MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 2011;197:80-5. https://doi.org/10.2214/AJR.11.6740

피인용 문헌

  1. Baseline Wall Thickness Is Lower in Mucosa-Healed Segments 1 Year After Infliximab in Pediatric Crohn Disease Patients vol.64, pp.2, 2015, https://doi.org/10.1097/mpg.0000000000001222
  2. Dynamic Contrast-Enhanced MR with Quantitative Perfusion Analysis of Small Bowel in Vascular Assessment between Inflammatory and Fibrotic Lesions in Crohnʼs Disease: A Feasibility Study vol.2019, pp.None, 2019, https://doi.org/10.1155/2019/1767620
  3. Detection of Crohn’s disease with diffusion images versus contrast-enhanced images in pediatric using MR enterography with histopathological correlation vol.124, pp.12, 2015, https://doi.org/10.1007/s11547-019-01067-z