Practice Rational Imaging

Magnetic resonance imaging in Crohn’s disease

BMJ 2008; 336 doi: (Published 31 January 2008) Cite this as: BMJ 2008;336:273
  1. Rakesh Sinha, consultant gastrointestinal radiologist and lecturer 1,
  2. Chuka Nwokolo, professor and consultant gastroenterologist2,
  3. Paul D Murphy, consultant colorectal surgeon3
  1. 1Department of Radiology, Warwick Hospital, South Warwickshire NHS Trust and Warwick Medical School, Warwick CV34 5BW
  2. 2Department of Gastroenterology, University Hospital of Coventry and Warwickshire, Coventry CV22 2DX
  3. 3Department of Surgery, Warwick Hospital, South Warwickshire NHS Trust, Warwick CV34 5BW
  1. Correspondence to: R Sinha rakslide{at}
  • Accepted 2 October 2007

This article explores the use of magnetic resonance imaging as an emerging modality in the investigation of Crohn’s disease

Learning points

  • Traditional imaging of Crohn’s disease has relied on barium examinations and conventional enteroclysis. These tests have the disadvantage that they lack extraintestinal detail. Barium examinations may also result in a large number of false negative results

  • Ultrasonography of the bowel has high sensitivity for diagnosing inflammatory bowel disease but is highly operator dependent, and comprehensive evaluation of the bowel may be hampered by excessive bowel gas and overlapping bowel loops

  • Computed tomography has high sensitivity for diagnosing intestinal and extraintestinal abnormalities in inflammatory bowel disease. However, this technique carries a high radiation dose, which may prohibit its use in young patients or patients who need repeated investigations

  • Magnetic resonance imaging is an emerging modality that has high sensitivity for detecting intestinal and extraintestinal changes in Crohn’s disease. This non-ionising technique provides excellent tissue contrast resolution and can help reduce the amount of radiation that patients receive

The patient

A 35 year old man presented with multiple discharging fistulas through the midline below the umbilicus and left iliac fossa. At seven years of age, he had had a colectomy with an ileostomy for Crohn’s disease.

What is the next investigation?

Imaging in Crohn’s disease aims to detect the presence of ulceration, fistulas, bowel oedema, strictures, and extraintestinal abnormalities.

Plain abdominal radiograph

Plain abdominal radiography may help identify complications related to Crohn’s disease, such as bowel obstruction or perforation, but it has a limited role assessing inflammatory activity.

Barium examinations

Radiological imaging of the small bowel has traditionally relied on barium examinations. Barium examinations, however, result in a considerable number of false negative results.1 A barium examination may also overlook extramural complications such as fistulas, …

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