Unexpected Findings Seen on MRI-Enterography Evaluation of Crohn's Disease

Magnetic resonance imaging (MRI) is increasingly used in the evaluation of small bowel Crohn's disease (CD). Unlike traditional radiology, MRI enables visualization of disease extension beyond the intestinal wall, i.e., abscesses and fistulas. However, some extra-intestinal findings have been seen that were both unexpected and without relation to CD.

The ability to detect incidental findings presents a clinical dilemma. On one hand, modern imaging techniques may detect early extra-intestinal malignant disease or disease requiring clinical intervention, thereby reducing morbidity and mortality. On the other hand, incidental findings may lead to additional diagnostic work-up or surgery of benign lesions causing increased morbidity.

A research article published January 7, 2010, in the World Journal of Gastroenterology addresses incidental findings in MRI-enterography in patients with suspected or known CD. Only few studies have dealt with incidental findings in abdominal MRI scans. In the present study, performed by investigators from the Medicinsk Gastroenterologisk Afdeling S (Aalborg, Denmark) and Odense Universitetshospital (Odense, Denmark), MRI-enterography revealed incidental findings located outside the small intestine, which were not related to CD in 25% of patients resulting in further examinations in 5%. Additional investigations confirmed abnormal lesions in 1.8%, and one patient had a malignant disease.

Two patients benefited from the additional examinations (aortic aneurysm and prostate cancer) whereas incidental findings led to unnecessary examinations in nine patients. Detection of extraintestinal manifestations of CD was rare (1.8%). Therefore, incidental findings are common in patients having MRI scanning for evaluation of small bowel CD.

Additional examinations reveal important disease in a minority of patients. However, a considerable number of patients experienced unnecessary morbidity because of the additional investigations of benign or normal conditions. The detection rate of significant incidental lesions not related to CD is too low to be an argument in itself for performing MRI-enterography in this group of patients, according to the investigators.

Related Links:
Medicinsk Gastroenterologisk Afdeling S
Odense Universitetshospital