Crohn's disease: the usefulness of MR enterography in the detection of recurrence after surgery

Objectives: To determine the usefulness of MR enterography in the detection of recurrence in the ileocolonic anastomosis in patients with Crohn's disease that have undergone intestinal resection. Material and methods: We used MR enterography and ileocolonoscopy to study 30 patients with Crohn's disease who had undergone intestinal resection. To determine the degree of relapse, the findings at MR enterography were quantified using our own index of Crohn's disease activity and the findings at ileocolonoscopy were quantified using the Rutgeerts scale. Ileocolonoscopy was considered the gold standard. Results: Compared to the gold standard, MR enterography yielded 100% sensitivity, 60% specificity, 92.6% positive predictive value (PPV), 100% negative predictive value (NPV), and 93.3% diagnostic accuracy. The concordance between the degree of recurrence determined with MR enterography and with ileocolonoscopy was moderate (kappa = 0.41). However, when patients were classified into two groups (high or low grade) according to outcome and the possibility of repeat surgery, the concordance was excellent (kappa = 0.87). Using this classification, MR enterography had 85% sensitivity, 100% specificity, 100% PPV, and 76.9% NPV. Conclusions: MR enterography is a useful imaging method for detecting recurrence of Crohn's disease after surgery and for differentiating between patients with higher or lower risk of poor outcome. MR enterography has good concordance with ileocolonoscopy and is an alternative to ileocolonoscopy in determinate occasions. (C) 2010 SERAM. Published by Elsevier Espana, S. L. All rights reserved.