What is the sensitivity of Magnetic Resonance Imaging (MRI) enterography in diagnosing active Crohn's disease?

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From the Guidelines

MRI enterography is highly sensitive for diagnosing active Crohn's disease, with sensitivity values ranging from 66% to 95%. This imaging technique effectively detects key markers of active inflammation including mural and perienteric features of disease, such as wall thickening, hyperenhancement, and edema, as well as penetrating disease complications like fistulae, abscesses, and bowel perforation 1. The high diagnostic performance of MRI enterography is attributed to its ability to visualize the small bowel and evaluate transmural inflammation, making it an excellent non-invasive option for diagnosing active Crohn's disease, monitoring disease progression, and evaluating treatment response. Some of the key features that contribute to the high sensitivity of MRI enterography include:

  • Mural features such as wall thickening, hyperenhancement, and edema
  • Perienteric features like engorged vasa recta, fibrofatty proliferation, and lymphadenopathy
  • Penetrating disease complications including sinus tracts, fistulae, abscesses, inflammatory masses, and bowel perforation 1. The use of IV contrast in MRI enterography may improve sensitivity for detecting penetrating Crohn disease complications in children, but recent evidence suggests that it may not be necessary for detecting active inflammation in the terminal ileum and colon 1. Overall, MRI enterography is a valuable tool for diagnosing and managing active Crohn's disease, offering a sensitive and non-invasive alternative to endoscopy and other imaging modalities.

From the Research

Sensitivity of MRI Enterography in Diagnosing Active Crohn's Disease

  • The sensitivity of MRI enterography in diagnosing active Crohn's disease is supported by several studies 2, 3, 4, 5, 6.
  • A study published in 2014 found that the Magnetic Resonance Enterography Global Score (MEGS) correlated significantly with fecal calprotectin levels, with a correlation coefficient of 0.46 (P < 0.001) 3.
  • Another study published in 2017 compared the performance of CT enterography and MR enterography in detecting active Crohn's disease in children and adolescents, and found that mural features such as wall thickening and mural hyperenhancement had high sensitivity and specificity for active inflammation on both CT and MR enterography 4.
  • A study published in 2019 found that fecal calprotectin levels, Magnetic Resonance Index of Activity (MaRIA), and Crohn's Disease Endoscopic Index of Severity (CDEIS) were highly correlated, with positive and significant Pearson and Spearman coefficients (P < 0.0001) 6.
  • The use of MRI enterography in diagnosing active Crohn's disease is also supported by a study published in 2016, which highlighted the importance of MRI enterography in assessing Crohn's disease activity and treatment response 2.
  • Overall, the evidence suggests that MRI enterography is a sensitive and useful tool in diagnosing active Crohn's disease, with high correlation with other diagnostic markers such as fecal calprotectin and endoscopic indices 3, 4, 6.

Key Findings

  • Mural features such as wall thickening and mural hyperenhancement are highly sensitive and specific for active inflammation on MRI enterography 4.
  • The Magnetic Resonance Enterography Global Score (MEGS) correlates significantly with fecal calprotectin levels 3.
  • Fecal calprotectin levels, MaRIA, and CDEIS are highly correlated, with positive and significant Pearson and Spearman coefficients (P < 0.0001) 6.
  • MRI enterography is a useful tool in assessing Crohn's disease activity and treatment response 2.

References

1
Guideline

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Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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