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©2009 The WJG Press and Baishideng.
World J Gastroenterol. Jul 21, 2009; 15(27): 3367-3375
Published online Jul 21, 2009. doi: 10.3748/wjg.15.3367
Published online Jul 21, 2009. doi: 10.3748/wjg.15.3367
Table 1 Grouping by MRI findings
Category 1 | Category 2 | Category 3 | Category 4 | |
Mucosal enhancement | Nil | Mild | Mild | Mild or marked |
Transmural enhancement | Nil | Nil or mild | Nil or mild | Marked |
Wall thickness (mm) | > 3 | < 6 | > 6 | > 3 |
Table 2 Characteristics of the CD patients prior to the MRI examination
CD (n = 52) | |
Gender: male | 38.5% (20/52) |
Age at diagnosis (yr) | 38.9 ± 16.0 (14-79) |
A1 ≤ 16 | 11.5% (6/52) |
A2 17-40 | 55.8% (29/52) |
A3 > 40 | 32.7% (17/52) |
Crohn’s disease | |
L1 Terminal ileum | 78.8% (41/52) |
L2 Colon | 0% (0/52) |
L3 Ileocolonic | 19.2% (10/52) |
L4 Upper GI | 7.7% (4/52) |
P Perianal | 9.6% (5/52) |
B1 Non-stricturing | |
Non-penetrating | 75.0% (39/52) |
B2 Stricturing | 19.2% (10/52) |
B3 Penetrating | 5.8% (3/52) |
Colectomy | 11.5% (6/52) |
Terminal ileal resection | 25.0% (13/52) |
Proximal SB resection | 1.9% (1/52) |
Table 3 MRI findings of patients according to the MRI category
MRI group (n) | Male (%) | Age (yr) | Bowel length involved (cm) | Wall thickness (mm) | Degree of SB wall enhancement | Mucosal enhancement (%) | Transmural enhancement (%) | Mesenterichyperaemia (%) | Fibrofatty proliferation (%) | Regional lymph nodes (%) | Free fluid (%) | Narrowed lumen no hold-up (%) | Prestenotic dilation ± holdup (%) | Fistula (%) |
1 (7) | 28.6 | 37.9 ± 9.4 | 6.3 ± 7.9 | < 3 0% | None 100% | 0 | 0 | 0 | 14.3 | 0 | 14.3 | 57.1 | 14.3 | 0 |
(23-54) | (1-25) | 3-6 71.4% | Mild 0% | |||||||||||
> 6 28.6% | Marked 0% | |||||||||||||
2 (9) | 22.2 | 32.8 ± 9.2 | 13.8 ±12.3 | < 3 11.1% | None 0% | 100 | 88.9 | 33.3 | 33.3 | 66.6 | 33.3 | 44.4 | 0 | 22.2 |
(17-78) | (3-30) | 3-6 88.9% | Mild 100% | |||||||||||
> 6 0% | Marked 0% | |||||||||||||
3 (16) | 43.8 | 40.1 ± 16.2 | 16.2 ± 12.0 | < 3 0% | None 0% | 93.8 | 43.8 | 50.0 | 62.5 | 37.5 | 18.8 | 18.8 | 62.5 | 25.0 |
(14-79) | (2-50) | 3-6 0% | Mild 100% | |||||||||||
> 6 100% | Marked 0% | |||||||||||||
4 (20) | 45.0 | 41 ± 19.2 | 19.2 ± 11.6 | < 3 0% | None 0% | 100 | 90.0 | 75.0 | 75.0 | 85.0 | 35.0 | 35.0 | 35.0 | 20.0 |
(14-49) | (2-45) | 3-6 10% | Mild 0% | |||||||||||
> 6 90% | Marked 100% |
Table 4 MRI category, medical therapy and clinical response (%)
MRI group | Steroids | 5ASA | Antibiotics | AZA/6MP | MTX | Anti-TNF α | Response |
1 (n = 7) | 57.10 | 57.10 | 28.50 | 85.70 | 0.00 | 42.90 | 14.30 |
2 (n = 9) | 55.50 | 88.90 | 0.00 | 22.20 | 33.30 | 44.40 | 100.00 |
3 (n = 16) | 81.30 | 68.80 | 6.30 | 50.00 | 0.00 | 12.50 | 43.80 |
4 (n = 20) | 70.00 | 70.00 | 5.00 | 40.00 | 0.00 | 35.00 | 50.00 |
Responders (n = 27) | 63.00 | 63.00 | 11.10 | 44.40 | 3.70 | 25.90 | N/A |
Non-responders (n = 25) | 76.00 | 80.00 | 4.00 | 48.00 | 8.00 | 36.00 | N/A |
Table 5 MRI category, response to medical therapy in relation to luminal narrowing with and without hold up
MRI group | No narrowed lumen | Narrowed lumen no hold up | Narrowed lumen with hold up |
1 | Response 0% (0/2) | Response 25% (1/4) | Response 0% (0/1) |
n = 7 | No response 100% (2/2) | No response 75% (3/4) | No response 100% (1/1) |
2 | Response 100% (5/5) | Response 100% (4/4) | Response N/A |
n = 9 | No response 0% (0/5) | No response 0% (0/4) | No response N/A |
3 | Response 66.7% (2/3) | Response 66.7% (2/3) | Response 40% (4/10) |
n = 16 | No response 33.3% (1/3) | No response 33.3% (1/3) | No response 60% (6/10) |
4 | Response 83.3% (5/6) | Response 57.1% (4/7) | Response 14.3% (1/7) |
n = 20 | No response 16.7% (1/6) | No response 42.9% (3/7) | No response 85.7% (6/7) |
Total | Response 75.0% (12/16) | Response 61.1% (11/18) | Response 27.8% (5/18) |
n = 52 | No response 25.0% (4/16) | No response 38.9% (7/18) | No response 72.2% (7/18) |
Table 6 Correlation of MRI findings with surgical pathology
No. | Sex | Age | MRI assessment | Surgical pathology | |||
Group | Fistula | Inflammation | Fibrosis | Fistula | |||
1 | F | 23 | 1 | No | Minimal | Yes | No |
2 | M | 45 | 1 | No | No | Yes | No |
3 | F | 39 | 2 | Yes | Mild | No | Yes |
4 | M | 17 | 3 | No | Mild | Yes | No |
5 | F | 59 | 3 | No | Mild | Yes | No |
6 | F | 31 | 3 | No | Mild | Yes | No |
7 | M | 18 | 3 | No | Moderate | Yes | No |
8 | M | 24 | 3 | Yes | Mild | Yes | Yes |
9 | F | 37 | 3 | No | Mild | Yes | No |
10 | M | 41 | 3 | No | Mild | Yes | No |
11 | F | 62 | 4 | No | Florid | Yes | No |
12 | M | 19 | 4 | No | Florid | Yes | No |
13 | M | 61 | 4 | No | Florid | Yes | No |
14 | F | 21 | 4 | Yes | Florid | No | Yes |
15 | M | 43 | 4 | Yes | Florid | Yes | Yes |
16 | M | 14 | 4 | No | Florid | No | No |
17 | F | 56 | 4 | No | Florid | No | No |
- Citation: Lawrance IC, Welman CJ, Shipman P, Murray K. Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology. World J Gastroenterol 2009; 15(27): 3367-3375
- URL: https://www.wjgnet.com/1007-9327/full/v15/i27/3367.htm
- DOI: https://dx.doi.org/10.3748/wjg.15.3367