MRI as accurate as CT for Crohn’s disease detection, management

Both MRI and CT are highly accurate when it comes to detecting Crohn’s disease in the small intestine, and MRI can be the go-to modality when radiation exposure is an issue—as can be the case due to the repetitive imaging that’s often indicated for managing this chronic inflammatory bowel disease.

The conclusions are from a meta-analysis of the literature conducted at the University of South China in Hunan Province. Academic Radiology published the findings online June 5.

Wenhong Liu, MD, and colleagues systematically searched PubMed, Elsevier, ScienceDirect, Karger, Web of Science, Wiley Online Library and Springer for studies in which CT or MRI were evaluated to assess small-bowel Crohn’s.

Focusing their analysis on 21 studies involving 913 patients, they found no significant differences in performance between the two modalities.

“[A]lthough each technique has its own unique advantages and limitations in clinical practice, these modalities are equally highly accurate techniques in assessing small-bowel Crohn’s disease in the present meta-analysis,” the authors write.

The authors note in their discussion that, over the last decade, CT has largely supplanted endoscopy and barium fluoroscopy to become the first-line modality for evaluating patients with Crohn’s disease as well at the most appropriate choice for diagnosing those suspected of having the condition.

“However, the issue of radiation risk owing to the large dose of ionizing radiation used for CT detection, particularly repetitive imaging required during CD remission and relapse, has received more and more attention in recent years,” they write. “Although several modifications were introduced to lower the radiation dose recently, such as shorten the exposure time, alterations of voltage and amperage, and noise-reduction filters, the cumulative radiation exposure by recurrent CT examinations is still of great concern.”

The authors state that theirs is the first study to use meta-analysis for directly comparing, specifically, MR enterography and/or enteroclysis with CT enteroclysis and/or enterography for detecting active Crohn’s disease in the small intestine.

“MR enteroclysis, MR enterography and CT enterography are all highly accurate techniques in assessing small-bowel Crohn’s disease,” they conclude. “MRI has the potential to be the first-line radiation-free modality for small-bowel Crohn’s disease imaging.”