PET/MR versus PET/CT imaging: Impact on the clinical management of small-bowel Crohn's disease

Gianluca Pellino, Emanuele Nicolai, Onofrio A. Catalano, Severo Campione, Francesco P. D'Armiento, Marco Salvatore, Alberto Cuocolo, Francesco Selvaggi

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Aims: The aim of this study was to compare the accuracy and clinical impact of hybrid positron emission tomography [PET]/magnetic resonance-enterography [MR-E] and PET/computed tomography-enterography [CT-E] in patients with Crohn's disease [CD]. Methods: A total of 35 patients with symptomatic small-bowel CD who were scheduled to undergo operation were evaluated before operation by same-day PET/CT-E and PET/MR-E. PET/MR-E was also compared with MR-E alone. Imaging accuracy for detecting pathological sites and discriminating between fibrotic and inflammatory strictures was assessed. Treatment was adjusted according to imaging findings and change in medical/surgical strategy was also evaluated. Results: PET/CT-E, PET/MR-E, and MR-E were equally accurate in detecting CD sites. PET/MR-E was more accurate in assessing extra-luminal disease [p = 0.002], which was associated with higher need for stoma [p = 0.022] and distant localisation [p = 0.002]. When the latter was observed, laparoscopy was started with hand-assisted device, reducing operative time [p = 0.022]. PET/MR-E was also more accurate in detecting a fibrotic component compared with PET/CT-E [p = 0.043] and with MR-E [p = 0.024]. Fibrosis was more frequently classified as inflammation with MR-E compared with PET/MR-E [p = 0.019]. Out of 8 patients with predominantly inflammatory CD who received medical treatment, 6 [75%] remained surgery free. Overall, 29 patients received surgery. At median follow-up of 9 [6-22] months, no recurrences occurred in either the medical or the surgical group. Conclusions: Preoperative PET/MR-E imaging is highly accurate for assessing CD lesions before operation and contributed to clinical management of patients with small-bowel CD more often than PET/CT-E.

Original languageEnglish
Pages (from-to)277-285
Number of pages9
JournalJournal of Crohn's & colitis
Volume10
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • Crohn's disease
  • Diagnosis
  • Fibrosis
  • Inflammation
  • Magnetic resonance imaging
  • Pathology
  • Surgery

ASJC Scopus subject areas

  • Gastroenterology

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