Magnetic resonance enterography in pregnant women with Crohn’s disease: case series and literature review

BMC Gastroenterology

Marianne Michal Amitai²  Sarah Apter²  Shomron Ben-Horin¹  Uri Kopylov¹  Myriam D Stern² 

[1] Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel;Department of Diagnostic Imaging, Sheba Medical Center, Ramat Gan, Israel

关键词: MRI;    Magnetic resonance enterography;    Pregnancy;    Crohn’s disease;   

Others  :  1121841
DOI  :  10.1186/1471-230X-14-146

 received in 2014-03-11, accepted in 2014-08-13,  发布年份 2014

【 摘 要 】

Background

Evaluation of pregnant women with known or suspected Crohn’s disease (CD) remains a challenge. Magnetic Resonance Enterography (MRE) is a promising diagnostic tool in these patients; however, the clinical data on MRE utilization in pregnancy is scarce. The aim of the study was to describe the experience with MRE in pregnant CD patients in a tertiary referral center.

Methods

We retrospectively reviewed MRE studies performed in pregnant women with known or suspected CD that were performed between January 2007 and November 2012. Imaging findings, clinical management and outcome were extracted from patient’s file and electronic records. Image quality was evaluated.

Results

Ten studies of 9 patients were included. MRE protocol was modified to maximize maternal and fetal safety, and intravenous gadolinium was not used. In 7 patients, CD diagnosis was previously established; six were admitted with clinical symptoms consistent with CD exacerbation, and an additional patient with a recurrent groin abscess without apparent luminal symptoms. In all seven patients, imaging features consistent with active CD were detected; new penetrating complications were detected in 4 patients. Two patients underwent MRE for suspected CD which was not comforted by study results. The clinical management was significantly impacted by MRE results in all positive cases. The image quality of the fast MRE sequences obtained without gadolinium was satisfactory and allowed meaningful interpretation.

Conclusion

MRE with an adapted protocol for pregnancy is a reliable imaging modality to manage in pregnant women with known or suspected CD.

【 授权许可】

   
2014 Stern et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Beaulieu DB, Kane S: Inflammatory bowel disease in pregnancy. World J Gastroenterol 2011, 17:2696.
• [2]Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC, Danese S, Halligan S, Marincek B, Matos C, Peyrin-Biroulet L, Rimola J, Rogler G, van Assche G, Ardizzone S, Ba-Ssalamah A, Bali MA, Bellini D, Biancone L, Castiglione F, Ehehalt R, Grassi R, Kucharzik T, Maccioni F, Maconi G, Magro F, Martín-Comín J, Morana G, Pendsé D, Sebastian S, et al.: Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohn’s Colitis 2013, 7:556-585.
• [3]Beniada A, Benoist G, Maurel J, Dreyfus M: Inflammatory bowel disease and pregnancy: report of 76 cases and review of the literature. J Gynecol Obstet Biol Reprod 2005, 34:581-588.
• [4]Bortoli A, Pedersen N, Duricova D, D'Inca R, Gionchetti P, Panelli MR, Ardizzone S, Sanroman AL, Gisbert JP, Arena I, Riegler G, Marrollo M, Valpiani D, Corbellini A, Segato S, Castiglione F, Munkholm P, European Crohn-Colitis Organisation (ECCO) Study Group of Epidemiologic Committee (EpiCom): Pregnancy outcome in inflammatory bowel disease: prospective European case‒control ECCO‒EpiCom study, 2003–2006. Aliment Pharmacol Ther 2011, 34:724-734.
• [5]Caprilli R, Gassull MA, Escher JC, Moser G, Munkholm P, Forbes A, Hommes DW, Lochs H, Angelucci E, Cocco A, Vucelic B, Hildebrand H, Kolacek S, Riis L, Lukas M, de Franchis R, Hamilton M, Jantschek G, Michetti P, O'Morain C, Anwar MM, Freitas JL, Mouzas IA, Baert F, Mitchell R, Hawkey CJ: European evidence based consensus on the diagnosis and management of Crohn’s disease: special situations. Gut 2006, 55:i36-i58.
• [6]Smink M, Lotgering F, Albers L, de Jong D: Effect of childbirth on the course of Crohn’s disease; results from a retrospective cohort study in the Netherlands. BMC Gastroenterol 2011, 11:6.
• [7]Ilnyckyj A, Blanchard JF, Rawsthorne P, Bernstein CN: Perianal Crohn’s disease and pregnancy: role of the mode of delivery. Am J Gastroenterol 1999, 94:3274-3278.
• [8]Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, Ron E, Sachs RK, Samet JM, Setlow RB, Zaider M: Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A 2003, 100:13761-13766.
• [9]Amitai MM, Ben-Horin S, Eliakim R, Kopylov U: Magnetic resonance enterography in Crohn’s disease: a guide to common imaging manifestations for the IBD physician. J Crohn’s Colitis 2013, 7:603-615.
• [10]Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley WG Jr, Froelich JW, Gilk T, Gimbel JR, Gosbee J, Kuhni-Kaminski E, Lester JW Jr, Nyenhuis J, Parag Y, Schaefer DJ, Sebek-Scoumis EA, Weinreb J, Zaremba LA, Wilcox P, Lucey L, Sass N: ACR guidance document for safe MR practices: 2007. Am J Roentgenol 2007, 188:1447-1474.
• [11]Ziech ML, Bossuyt PM, Laghi A, Lauenstein TC, Taylor SA, Stoker J: Grading luminal Crohn’s disease: which MRI features are considered as important? Eur J Radiol 2012, 81:e467-e472.
• [12]Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J, Ayuso C, Ricart E, Panés J: Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 2011, 17:1759-1768.
• [13]Steward MJ, Punwani S, Proctor I, Adjei-Gyamfi Y, Chatterjee F, Bloom S, Novelli M, Halligan S, Rodriguez-Justo M, Taylor SA: Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 2012, 81:2080-2088.
• [14]Colombel JF, Sandborn WJ, Reinisch W, Mantzaris GJ, Kornbluth A, Rachmilewitz D, Lichtiger S, D'Haens G, Diamond RH, Broussard DL, Tang KL, van der Woude CJ, Rutgeerts P: Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 2010, 362:1383-1395.
• [15]Shoenut JP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB: MRI in the diagnosis of Crohn’s disease in two pregnant women. J Clin Gastroenterol 1993, 17:244-247.
• [16]Oto A, Ernst RD, Ghulmiyyah LM, Nishino TK, Hughes D, Chaljub G, Saade G: MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 2009, 34:243-250.
• [17]Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC: MRI of acute abdominal and pelvic pain in pregnant patients. Am J Roentgenol 2005, 184:452-458.
• [18]Neubauer H, Pabst T, Dick A, Machann W, Evangelista L, Wirth C, Köstler H, Hahn D, Beer M: Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatr Radiol 2013, 43:103-114.