The mutually complementary role of magnetic resonance enterography and conventional enteroclysis in patients with complicated and/or advanced stage of Crohn's disease.

AIM: To assess the diagnostic significance of magnetic resonance enterography (MRE) and conventional enteroclysis (CE) in patients with complicated and/or advanced stage of Crohn's disease. METHODS: Patients with abnormal CE findings suggestive of mural and/or extramural involvement with the diagnosis or pre-diagnosis of CD are evaluated. After real-time bowel distension by enteroscopic examination, the patients with advanced or complicated stage were taken to the MRE examination in the same session. Mucosal-mural-extramural and activation findings, presence of stenosis/stricture, skip lesions and the mean duration of exams were evaluated with both CE and MRE. The superiority of one method over the other relative to these findings was evaluated. RESULTS: A total of 110 patients evaluated by CE had the findings of CD. Of these, 24 patients with abnormal CE findings suggestive of advanced mural and extramural involvements were subsequently evaluated with MRE. CE was superior to MRE in the depiction of early superficial mucosal changes (aphthous-linear ulcer), cobblestone pattern (p = 0.002, p < 0.01), obstruction (p = 0.004, p < 0.01), and differentiation between the string sign and stricture. MRE was superior to conventional enteroclysis in mural and perienteric findings of bowel thickening, fibro-fatty proliferation, abscess (p = 0.016, p 0.05). CONCLUSION: CE and MRE are mutually complementary imaging modalities in CD staging, evaluation of activation findings, and detection of complications (Tab. 3, Fig. 8, Ref. 23).

Magnetic resonance visualization of iron-loaded meshes in patients with pain after inguinal hernia repair.

PURPOSE: Chronic post-operative inguinal pain (CPIP) is defined as pain lasting more than 3 months and the incidence is less than 4% after laparoscopic hernia repair. CPIP can have several causes. In this study, we aimed to show that 3D-iron loaded mesh preparations are useful in radiological evaluation of post-operative complications, especially patients with chronic pain and the mesh status of operated inguinal hernia cases. METHODS: A total of 450 cases who had been operated for inguinal hernia with 3D-iron loaded mesh and who had ongoing pain at the post-operative period were included in this study. MRI (Magnetic Resonance Imaging) was performed at the post-operative 90th day of the seven symptomatic (groin pain, limitation of movement) cases which were operated using a 3D-iron loaded mesh, 10 × 15 cm in size, (DynaMeshEndolap visible with 25% MRI-visible filaments, FEG TextiltechnikmbH, Aachen, Germany) for inguinal hernia repair to evaluate mesh status, localization, and local complications. Gradient echo sequences in the sagittal, axial, and coronal sections on MRI were discussed by two radiologists. Mesh localizations, their relationship with surrounding structures and their complications related with mesh were evaluated by two radiologists (D.Y, D.E.T.S). RESULTS: No significant radiological findings related to defined anatomical structures were found in the MRI images of the study group. The dimensions measured on the sagittal, axial and coronal images were correlated with original mesh sizes and no significant shrinkage was detected. CONCLUSION: Mesh position and deformation as shrinkage can be the mesh-related cause of pain. The incidence of CPIP in our patients is less than 2%. 3D-iron loaded meshes were monitored with MRI in CPIP patients and there was no mesh-related changes found in our study. The use of MRI-visible meshes will most likely help us to monitor mesh preparations and show potential time-dependent changes in mesh characteristics and consequent complications. In case of doubtful clinical postoperative hernia recurrence or chronic groin pain, mesh position can be identified by MRI and unnecessary surgical intervention can be avoided.