Crohn's disease evaluation: Comparison of contrast-enhanced MR imaging andsingle-phase helical CT scanning

The purpose of this study was to evaluate the use of gadolinium and barium- enhanced magnetic resonance (MR) imaging in detecting intestinal and extrai ntestinal Crohn's disease and compare MRI with contrast-enhanced helical co mputed tomography (CT), Twenty-six patients with Crohn's disease underwent imaging examinations, including gadolinium-enhanced, fat suppressed fast mu ltiplanar spoiled gradient-recalled (FMPSPGR) NIR imaging with oral 2% bari um sulfate and rectal water and with helical CT using IV and positive (13) or negative (13) intestinal contrast material, NIR images and CT scans were reviewed separately by two radiologists for bowel wall thickness and enhan cement, presence of abscess, phlegmon, and fistula. MR images and CT scans were then compared side by side. Surgical, endoscopic, and histopathologic findings and results of barium studies were reviewed to determine the locat ion and severity of involvement of intestinal Crohn's disease, Depiction of mural thickening and/or enhancement was superior on the MR images, which s howed 55 (85%) and 52 (80%) of 65 abnormal bowel segments for the two obser vers, compared with helical CT, which showed 39 (60%) and 42 (65%; P < 0.00 1, P < 0.05) of bowel segments affected by Crohn's disease, Segments of bow el with moderate or marked mural thickening were depicted equally on MR ima ging and helical CT, In mildly diseased segments of bowel, with only slight thickening and enhancement, MR imaging depicted 22 (79%) and 19 (68%) of 2 8 segments, compared with helical CT, which depicted 9 (32%; P < 0.01), and 13 (46%; P > 0.05) of 28 segments. In the side-by side comparison, MR imag ing was preferred over helical CT for depicting normal bowel wall (MR 71%, CT 4%, equal 25%; P < 0.001), mural thickening (MR 41%, CT 11% equal 48%; P < 0.01), mural enhancement (MR 89%, equal 11%; P < 0.001), and overall GI tract evaluation (MR 52%, CT 10%, equal 38%; P < 0.001), Gadolinium-enhance d MR imaging with oral dilute barium sulfate and rectal water depicts intes tinal and extraintestinal changes of Crohn's disease and shows promise as a clinically useful tool. (C) 2000 Wiley-Liss, Inc.