Running Head: USE OF MRE TO DIAGNOSE CROHNS DISEASE

The Use of MRE As the Preferred Crohns Disease Diagnostic Test

Kaitlyn Richardson
Schoolcraft College

USE OF MRE TO DIAGNOSE CROHNS DISEASE

The Use of MRE As the Preferred Crohns Disease Diagnostic Test

Crohns Disease is an autoimmune disease that involves inflammation of the
gastrointestinal tract. Inflammation can occur anywhere from the mouth to the anus. Even though
the disease can exist anywhere in the gastrointestinal tract, 80% of the time it exists in the small
bowel (Arif-Tiwari et al., 2013). One of the characteristics of Crohns Disease is ulcers. These
ulcers are either superficial mucosal ulcers, which are ulcers on the surface of the mucous
membranes of the small bowel, or deep fissuring ulcers, which are ulcers that are formed when
there is a deep break in the mucous membrane (LeBedis et al., 2012). The whole thickness of the
bowel wall is affected by Crohns disease. Inflammation to the sub mucosal layer causes the
tissue of the small bowel wall to be destroyed leading to other complications like strictures,
fibrosis, and fistulae. Because of its wide range of symptoms and affected areas, Crohns Disease
can be hard to diagnose (Arif-Tiwari et al., 2013). Using imaging techniques is the most affective
way to diagnose and monitor Crohns Disease. While there are many imaging techniques out
there, Magnetic Resonance Enterography is beginning to prove to be the optimal choice for
diagnosing and monitoring Crohns Disease.
Imaging techniques are used to diagnose Crohns disease and it is also used to assess the
location of the disease, spot any other complications that may come with the disease, and to see
the severity of the disease through the inflammation of the intestine. The most common form of
imaging is Computed Tomography Enterography (CTE). A CTE views the sub mucosal tissue of
the whole intestine. It can also detect any active disease occurring in the small bowel as well as

USE OF MRE TO DIAGNOSE CROHNS DISEASE

any other complications that can come with Crohns disease. CTEs use ionizing radiation to
obtain the images. Another imaging technique is the endoscopic technique. One form is
illeocolonoscopy, which views the mucosa of the small bowel as well as provides a tissue sample
from the intestinal wall. This technique is great for detecting disease in the mucosa. One
downfall is that only a small part of the ileum of the small bowel is accessible. Another form of
endoscopic imaging is Video Capsule Endoscopy (VCE). VCE shows the mucosa of the whole
small bowel as apposed to the illeocolonscopy, which only visualizes the mucosa of the ileum. It
also does not provide any tissue samples like the ileocolonoscopy does. The third type of
imaging is a small bowel follow through. A SBFT is an evaluation of the entire small bowel. It is
used to detect any disease in the mucosa, any ulcers, and any other complications. This form of
imaging uses an x-ray, as well as, an oral contrast that coats the intestine for optimal
visualization (Arf-Tiwari et al., 2013).
While all of these types of imaging seem like a great way to detect Crohns disease, there
are many reasons why an MRE might be preferred. Like a CTE scan, an MRE can view the sub
mucosal tissue of the entire small bowel. But MRE can also determine if there is any
inflammation and the extent of the inflammation. It can also determine other things like fibrotic
disease and complications with in the abdomen. Lastly an MRE can provide images of
complications outside the intestines including things like a bowel obstruction, fistulae, and
abscesses. One of the main things that set an MRE apart form other imaging techniques, is that it
can differentiate whether inflammation from fibrosis is coming from within the sub mucosa of
the intestinal wall or within the tissue around the intestine (Arif-Tiwari et al., 2013).
Compared to CTE, both MRE and CTE visualized tissue deeper than the mucosa. But an
MRE does not use ionizing radiation like a CTE does. This poses the risk of developing cancer

USE OF MRE TO DIAGNOSE CROHNS DISEASE

(Arif-Tiwari et al., 2013). Using an MRE instead of a CTE is ideal for Crohns Disease patients
that have to have many CT scans. This reduces the risk of developing cancer as a result of
radiation. An MRE can detect active disease in just a few minutes without exposing patients to a
lot of radiation. This is especially important for IBD patients who are pregnant (LeBedis et al.,
2012). Another reason an MRE is preferred over a CTE is the fact that it can differentiate
between inflammation and fibrosis in the sub mucosal tissue (Arif-Tiwari et al., 2013). The last
advantage of an MRE over a CTE is that an MRE can be used as an alternative for people who
have allergies to the contrast agents used for CT scans (LeBedis et al., 2012). Compared to a
VCE, an MRE does not detect as many lesions, but it can detect disease in deeper tissues than a
VCE can. The same goes for a SBFT. A SBFT cannot detect disease deeper than the mucosa; it
also cannot detect complications and disease outside of the alimentary canal like an MRE can
(Arif-Tiwari et al., 2013).
Magnetic Resonance Enterography is great at detecting active inflammation in the small
bowel. It can also detect other complications inside the intestines as well as outside the
intestines. It can differentiate between fibrosis and inflammation. It can visualize all across the
bowel as well as deeper than the mucosa, as compared to other imaging techniques that only
visualizes the mucosa. It also is a helpful way to detect the severity and extent of the
inflammation in the bowel. And most important of all it does not use ionizing radiation which
reduces the chances of patients developing cancer. While MREs are costly, have longer exam
times, and have a limited availability than other techniques, it overall produces better results for
detecting Crohns disease and it is safer for the patients.

USE OF MRE TO DIAGNOSE CROHNS DISEASE

References
Arif-Tiwari, H., Kalb, B., Chundru, S., Costello, J., Sauer, C. G., Martin, D. R., & ...
Goldschmid, S. (2013). The diagnostic role of magnetic resonance enterography in
Crohn's disease: An updated review of techniques, interpretation, and application.
Applied Radiology, 42(12), 5-15.
LeBedis, C. A., Penn, D. R., Broder, J. C., Gupta, A., Tkacz, J. N., & Soto, J. A. (2012). Current
applications of MRI in emergent gastrointestinal diseases. Applied Radiology, 41(11), 915.