The MRI And CT Charateristics Of Crohn’s Disease And The Application Of MRI Evaluating Its Activity Plus Clinical Comparative Study

Part one The comparison of MRI and CT characteristics of the bowelCrohn’s diseaseObjective: Apply suspected CD by clinic as objects of the study and all the patientstaking the endoscopy, surgery-pathology as the final diagnostic results, to analysis thefeature of the MR and CT images of the bowel Crohn’s disease and compare it betweenMRI and CT. Summarize the feature of the patients and make more evidence for theclinical diagnosis.Material and method: Forty-three cases suspected by clinic were analyzedretrospectively. All the patients were examinated with MRI, CT, and digestive endoscopy.The MR and CT images were independently analysed by two MRI doctors and CT doctors.All the images were reviewed for the location, mural thickness, and the stenotic degree ofdiseased bowel segments and for the complication.Record the data and compare with theresult of the surgery-pathology and endoscopy.Results: Among the forty-three cases,31case were diagnosed for CD by digestiveendoscopy, surgery and pathology,4cases for UC,2cases for GIST,1case for ITB,1casefor HSP, and1for PSIL. The coincidence of MRI is93.5%,90.3%by CT, but up to96%by MRI with digestive endoscopy, and the diagnostic function of MRE was well consistentwith CTE’ s (Kappa=0.788, P <0.05). Two or more than2segments of small-bowl wereinvolved in most cases. The ileocecum area was involved in27/25(27cases in MRI and25cases in CT) cases. The mural thickness and “comb sign” were evident in non-enhancedMRI. The wall thickness were mainly asymmetric in mildly thickened patients, butthickened roundly in severely thickened cases,(P <0.001both in MRI and CT). but P> 0.05in showing mildly, moderately thickened and severely thickened between MRI andCT.Conclusion: Our results have shown that the mural thickness and complications wereevident in both MRI and CT, and MRI is a sensitive examination to diagnose intenstinalCrohn’s disease, not only more effective in differentiating fistula and abscess, but alsomore suitable in long term follow-up. Part two: The application of MRI evaluating Crohn’s activity plusclinical comparative studyObjective: Taking CD patients that diagnosised for by clinic as objects and theclinical assessment as the finally standard of the study, we can value the disease activitythrough the feature of MRI imaging.Material and method: Forty-four cases (included32men and12women)diagnosised for CD by clinic were assessed the activity by the clinical standard. Accordingto the clinical data, the patients were divided into the active phase group and chronic phasegroup. All the patients underwent MRI, and the images were reviewed for the muralthickness, the stenotic degree of diseased bowel segments, for the mesentery, for the lymphnodes, and for the complications (abscess, inflammatory mass, and fistula) et al. therebydisease activity was assessed according to a multiparameter score, and MR findings werecompared with clinical data.Results: The clinical reference standard revealed28to have active disease and16tohave chronic disease, and MRI identified active disease in27cases and chronic disease inthe remaining17. Clinical diagnosis is the “gold standard”. Sensitivity of MR for thedepiction of the disease activity of CD was89.3%. Specificity was87.5%, positivepredictive value was92.6%, negative predictive value was82.4%, and the diagnosticfunction of MRI was well consistent with clinical (Kappa=0.758, P <0.05). In all thepatients,37cases involved two or more than2segments of small bowl, the ileocecum area was involved in40cases, enlarged mesareic lymph node was seen in18cases,“comb sign”was evident in19cases, fistula was detected in22cases. There was significant differencein severely thickness patients, showing the stenotic degree of diseased bowel segments,fistula, the lymph nodes and “comb sign” between active disease and chronic disease (P <0.05), which showed that active ones super to chronic ones.Conclusion: The diagnostic function of MRE was not only well consistent withclinical, but also make the right diagnostic for the mural thickness, for the significantenhancement, for the location and the complications. Besides, MRI is the preferredimaging method for the complication of Crohn’s disease.