Magnetic resonance enterography in Crohn’s disease patients: current state of the art and future perspectives

ABSTRACT

Introduction

Crohn’s disease (CD) is a major concern due to relatively high incidence and major complications like stricture or fistulas, often requiring surgical treatment. In recent years, magnetic resonance enterography (MRE) became a popular method of diagnosis and disease surveillance. The purpose of this review is to summarize and discuss the major and most recent advances in various aspects of MRE usage in diagnosong Crohn’s disease, and to discuss advances in technique, disease activity monitoring and response to treatment.

Methods

A literature search was performed and relevant publications were included, with emphasis on articles from the past decade.

Areas covered

In this review we have presented articles with major advances in the field of MRE of CD patients such as proper sequence selection, recent advances in scoring of disease activity, differentiation between inflammation and fibrosis, response to treatment and technological advances such as the use of AI.

Expert opinion

The main goal in improving MRE performance will be sequence selection aimed at differenting between inflammation and stricture while shortening the study length adjusted to patient compliance, and developing a standardized scoring system for MRE reporting assisted by artificial intelligence.

KEYWORDS:

• AI
• Crohn’s disease
• disease activity
• inflammatory bowel disease
• MRE

Article highlights

• Due to the chronic nature of Crohn’s disease and young age of patients, MRE became a popular imaging modality to diagnose the disease and to assess activity and complications.

• There are different recommended protocols, most of them including T2 weighted sequences and post contrast T1 weighted sequences. However, additional sequences can contribute, especially to inexperienced readers or when IV contrast injection is contraindicated.

• Different scoring systems were suggested in order to evaluate disease activity, and new and revised scorings are being published.

• The differentiation between inflamed and fibrotic bowel segments is important due to the different treatment options and is a major challenge and MRE can help differentiate the two.

• MRE is a good tool to evaluate response to treatment, and may even help predict response to treatment by evaluating features that are associated to a complicated disease.

• Few articles suggested the use of artificial intelligence in MRE, for example, in order to measure bowel wall thickness or to differentiate between inflammation and fibrosis by using texture analysis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.