What information should I include in a note to the imaging facility for a patient with Crohn's disease undergoing magnetic resonance enterography (MRE) or computed tomography enterography (CTE)?

From the Guidelines

When referring a patient with Crohn's disease for MRE or CTE, your note should include the patient's clinical history, current symptoms, disease duration, and location of known disease involvement, as this information is crucial for radiologists to optimize the imaging protocol and provide a clinically relevant assessment 1.

Key Information to Include

• Patient's clinical history, including disease duration and location of known disease involvement
• Current symptoms and any changes in symptoms
• Prior surgeries, particularly bowel resections
• Known strictures, fistulas, or abscesses
• Current medications, especially biologics, steroids, or immunomodulators, and their duration of use
• Allergies to contrast media and current renal function (eGFR or creatinine)
• Recent relevant imaging studies with dates and findings
• Clearly stated clinical question, such as disease activity assessment, complication evaluation, or treatment response
• Pregnancy status for female patients of childbearing age

Importance of Comprehensive Information

Including this comprehensive information in the note helps radiologists to:

• Optimize the imaging protocol
• Interpret findings in context
• Provide the most clinically relevant assessment
• Ensure patient safety regarding contrast administration
• Avoid unnecessary radiation exposure by preventing duplicate studies As stated in the consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn's disease, radiologists should indicate that inflammatory small bowel Crohn's disease is likely when either mural hyperenhancement and wall thickening are present, or when enteric inflammation is asymmetric or co-exists with the typical penetrating complications of Crohn's disease 1.

From the Research

Note to Imaging Facility for Patient with Crohn's Disease

When sending a note to the imaging facility for a patient with Crohn's disease undergoing magnetic resonance enterography (MRE) or computed tomography enterography (CTE), the following information should be included:

• Patient's medical history, including diagnosis of Crohn's disease and any previous treatments or surgeries 2, 3
• Current symptoms and disease activity, as this will help the imaging facility to tailor the exam protocol to the patient's specific needs 3, 4
• Any previous imaging studies, including results and dates, to allow for comparison and monitoring of disease progression 5, 6
• Specific questions or concerns that need to be addressed by the imaging study, such as assessment of disease activity, detection of complications, or evaluation of response to therapy 2, 3

Imaging Modalities

The choice of imaging modality, either MRE or CTE, should be based on the specific clinical question and the patient's individual needs. Considerations include:

• Radiation exposure: CTE involves ionizing radiation, while MRE does not 2, 5
• Soft tissue contrast: MRE provides better soft tissue contrast than CTE 2
• Availability and accessibility of the imaging modality: The choice of modality may be influenced by institution resources and patient preference 6

Exam Protocol

The exam protocol should include:

• Use of an enteric contrast agent for adequate bowel distention 2
• Use of an antiperistaltic agent to reduce motion artifacts 2
• Pre- and postcontrast sequences to evaluate disease activity and detect complications 2, 3