COMPARISON OF MAGNETIC-RESONANCE-IMAGING AND ENDOSCOPY IN DISTINGUISHING THE TYPE AND SEVERITY OF INFLAMMATORY BOWEL-DISEASE

Twenty consecutive patients with first-time presentation of suspected inflammatory bowel disease underwent both endoscopy with biopsy and ma gnetic resonance imaging (MRI) within a 3-day period; the relative abi lities of endoscopy and MRT to distinguish ulcerative colitis (UC) fro m Crohn's disease (CD) and to determine the severity of the disease pr ocess were compared. In 18 of 20 patients, a diagnosis of UC or CD cou ld be made on histological specimens. MRT correctly diagnosed 17 of th ese 18 patients using T1-weighted fat-suppressed spin echo and gadolin ium enhancement. Endoscopy correctly diagnosed 15 patients. Overall, M RI was not significantly better (p > 0.05) than endoscopy in distingui shing UC from CD. MRI correctly graded the severity of inflammatory ch anges in 13 of 20 patients, and endoscopy did so in 11 of 20. MRT and endoscopy findings were within one grade of histology findings in seve n patients each. No significant difference (p > 0.05) was found betwee n MRI and endoscopy in the ability to estimate the severity of the dis ease (as determined from biopsies). Bowel wall thickness measured on M R images demonstrated good correlation with percentage of contrast enh ancement: r 0.61; p = 0.003. Tn sum, magnetic resonance imaging was sh own to be comparable with endoscopy in differentiating UC from CD and in gauging the severity of disease. Transmural assessment, sagittal im aging, and the lack of invasiveness were attractive features of MRI.