Magnetic Resonance Enterography Findings of Intestinal Behçet Disease in a Child

SMALL BOWEL IS LARGELY AFFECTED IN BEHÇET’S DISEASE: A LONG-TERM FOLLOW-UP OF GASTROINTESTINAL SYMPTOMS

ABSTRACT Background Behçet’s disease is a rare immune-mediated disorder that can affect the gastrointestinal tract. The prevalence and extension of small bowel involvement is largely unknown. Objective The aim of this study was to describe the small bowel lesions diagnosed by double-balloon enteroscopy (DBE) and to verify if these findings were associated to the presence of gastrointestinal symptoms and disease activity after long-term follow-up. Methods This study included 19 Behçet’s disease patients who underwent DBE. After a mean follow-up of 15 years the endoscopic findings were associated to the presence of gastrointestinal symptoms, disease activity and current therapy through collection of electronic medical records. Results A total of 63.2% patients were female and the mean age was 37 years at the time of DBE. Mean disease duration at baseline was 24 years. 11 patients had no gastrointestinal symptoms and eight patients presented either abdominal pain, gastrointestinal bleeding or diarrhea. The average procedure time was 1 hour and 30 minutes and the ileum was achieved in all patients but one. Small bowel ulcers were diagnosed in 78.9%, with 63.1% of jejunal involvement. Two patients presented only small bowel edema and two were normal by DBE. Eight patients had concomitant gastric ulcers. Gastrointestinal symptoms prior to DBE were present in 36.8% of the patients and, after follow-up, all of them persisted with some of the symptoms. Bleeding was reported by three patients at baseline and persisted in only one patient. The frequency of treatment with steroids and immunomodulators was 31.6% and 57.9% at baseline, respectively, and 21% in both at the end of the follow-up. No patient was treated with biologics at the time of the DBE procedure and the current rate of biologic use is 21%. Conclusion Small bowel involvement in Behçet’s disease was frequently demonstrated by DBE even in asymptomatic patients. Understanding clinical evolution of the disease over the years and the impact of such diagnosis still represents a challenge, possibly with the need for novel treatment.

Overview of the Large Bowel Assessment using Magnetic Resonance Imaging: Different Techniques for Current and Emerging Clinical Applications

Radiological assessments of the small and large bowel are essential in daily clinical practice. Over X-ray plain films and ultrasound, cross-sectional techniques are considered the most comprehensive imaging modalities. "Cross-sectional techniques" refers to CT and MRI, as stated in the following sentence. In fact, computed tomography and magnetic resonance imaging take great advantage of the three-dimensional appraisal and the extensive evaluation of the abdominal cavity, allowing intestinal evaluation as well as detection of extra-intestinal findings. In this context, the chief advantage of computed tomography is the fast scan time, which is crucial for emergency cases. Nonetheless, it is undeniably impaired using ionizing radiation. As the awareness of radiation exposure is a topic of increasing importance, magnetic resonance imaging is not only becoming a mere alternative but also a primary imaging technique used in assessing intestinal diseases. Specifically, the evaluation of the large bowel through MRI can still be considered relatively uncharted territory. Although it has demonstrated superior accuracy in the assessment of some clinical entities from inflammatory bowel disease to rectal carcinoma, its role needs to be consolidated in many other conditions. Moreover, different technical methods can be applied for colonic evaluation depending on the specific disease and segment involved. This article aims to provide a thorough overview of the techniques that can be utilized in the evaluation of the large bowel and a discussion on the major findings in different colonic pathologies of primary interest.

Crohn's disease at radiological imaging: focus on techniques and intestinal tract

Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn's disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn's disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.

Fast Magnetic Resonance Enterography Protocol for the Evaluation of Patients with Crohn's Disease: A Pilot Study

OBJECTIVE

Magnetic resonance enterography has achieved an increasingly importance in the evaluation of patients with Crohn's disease, although it is limited by high costs and prolonged scanning times. The aim of our work was to design a "fast" abbreviated MRE protocol and to compare it with the standard one.

MATERIALS AND METHODS

A single-center retrospective study was performed on 73 patients with Crohn's disease who underwent MRE with standard protocol over a 7-month period. The images of the standard protocol were separated from those included in the proposed abbreviated one and independently evaluated by two radiologists with different years of experience in MRE imaging. Statistical analysis was performed with the Cohen kappa (κ) value, used to assess the agreement in case of categorical variables, the Lin's concordance correlation coefficient and Bland-Altman plot, in assessing the degree of agreement between numerical measurements, while the non- parametric Mann-Whitney U-test was used in comparing the evaluation times of the two protocols.

RESULTS

The intraobserver evaluation showed a perfect agreement between the two protocols for presence, number and extension of lesions, abdominal complications, and excellent/perfect in identification of active inflammation.The interobserver reproducibility was excellent for overall presence and number of lesions, for the presence and number of lesions in any abdominal quadrant, inflammation, intestinal and extraintestinal complications, and lesions extension.

CONCLUSION

The proposed protocol achieves comparable performance with standard MRE. Furthermore, it would carry potential benefits in terms of patient's comfort, time, and health-care costs savings.

MR enterography: what is next after Crohn's disease?

Within the gastrointestinal system, the small bowel represents the most difficult site to approach with imaging modalities. During the last decades, magnetic resonance enterography has reached an increasing interest, up to be considered an essential part in the diagnostic framework of Crohn's disease patients. Nevertheless, the distention of the intestinal loops provided by the administration of oral contrast medium, the possibility of a dynamic evaluation, and the lack of radiation exposure are huge advantages that can be exploited for the assessment of other clinical conditions affecting the small bowel. Physicians and radiologists should be aware of the possibilities offered by this technique, looking at it as a trustful alternative to the well-worn radiological examinations. In this respect, the purpose of this work is to show some uncommon clinical conditions that can be assessed with magnetic resonance enterography and that fall within the various differential diagnosis of the intestinal disorders.