The role of MRI in the intestinal complications in cystic fibrosis

Fibrosing colonopathy is a complication recently detected in children with cystic fibrosis (CF), and is thought to be associated with the use of high- strength pancreatic enzymes. The goal of this study was to evaluate the eff ectiveness of magnetic resonance (MR) in detecting possible pathologic gat findings in patients with CF under pancreatic enzyme treatment. Twenty-five patients with CF and pancreatic insufficiency, all under treatment with hi gh-dose pancreatic enzymes, were studied by MR. MR was performed on a 1.5-T magnet by T1-weighted, 2D-FLASH fat-suppression, breath-hold sequences bef ore and after intravenous administration of gadolinium, and by T2-weighted Turbo Spin-Echo (TSE) and Half-Fourier Acquisition Single-Shot Turbo, Spin Echo (HASTE) fat-suppression, breath-hold sequences. A superparamagnetic ne gative oral contrast agent was given 1.5 h before the examination. MR showe d a wall thickening of the terminal ileum and the ascending colon (>4-12 mm ) in 22 patients; nine of them (wall thickness > 4-6 min) showed both a mod erate hyperintensity of the bowel wall on T2-weighted sequences and an enha ncement after intravenous gadolinium. on T1-weighted sequences; 13 patients (wall thickness > 6-12 mm) showed both a great wall enhancement after intr avenous gadolinium and an increased signal intensity of the bowel wall on T 2-weighted sequences. Fecal impaction without bowel wall involvement was de tected in three patients. MR proved to be a useful, noninvasive, diagnostic tool for the evaluation of patients with CF and fibrosing colonopathy. The signal hyperintensity on T2-weighted sequences and the great wall enhancem ent after intravenous gadolinium administration indicating an acute edemato us condition, provide the clinicians useful information for the therapeutic adjustment. (C) 2001 Elsevier Science Inc. All rights reserved.