ABSTRACT
Background: The frequent and periodic evaluation of crohn's disease [CD] activity is vital in planning the proper therapy, surgical or pharmacological, monitoring drug effects and detecting post-operative recurrence. The evaluation of inflammation is currently based on a combination of clinical symptoms, physical findings, laboratory parameters, endoscopy and various radiology studies. So far, an absolute reference method to assess disease activity doesn't exist, and many parameters are used by the physicians
Objective: We investigated magnetic resonance imaging [MRI] as a tool to evaluate CD activity in newly diagnosed and follow up patients in correlation with clinical and laboratory markers represented by crohn's Disease Activity lndex [CDAI]
Patients and Methods: This study included 27 patients with proven CD. Twelve patients were included in their 1st month from initial diagnosis. Fifteen patients were regular follow up. Patient evaluation included: careful clinical evaluation, laboratory tests, colon ileoscopy, and if needed barium studies. MRI evaluation was performed at the level of the pathological bowel-loops for the following parameters: bowel-wall thickness [WT]; wall enhancement [WE]; and wall signal on T2- W [SPIR] images
Results: Clinically active disease with CDAI score above 150 was noted in fifteen patients. All 27 patients had ileal CD. Ten patients had ileocolonic CD. One patient had gastric in addition to her ileocolonic disease. Magnetic resonance imaging [MRI] findings were: WT was normal in all patients with inactive disease, while in patients with active disease WT was mild in 2 patients, moderate in 4 patients, and severe in 9 patients. WE was normal in 10 patients, and mild in 2 patients of the inactive disease patients, while mild in 8 patients, and severe in 7 patients of the active disease patients. In inactive disease patients T2Wsignal was mild in 1 patient, and absent in 11 patients, while it was high in 7 patients, and mild in 8 patients of the active disease patients. Statistically significant correlation was noted between WT and CDAI, WE and CDAI, and T2W and CDAI. Also, significant correlation was noted between WT and WE, and T2W and WE
Conclusion: MRI can play a larger role in the clinical assessment of CD activity. MRI has shown good accuracy in detecting the inflammatory changes of CD and in differentiating non-active form active disease