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Query: UMLS:C0010346 (Crohn's disease)
 21,615 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

For evaluating primary colonic and rectal malignancies, CT and MRI are often complementary imaging methods which are useful in assessing patients suspected of having extensive disease and in deciding whether a patient will benefit from preoperative radiation. CT is also helpful in designing radiation ports and in detecting complications related to the neoplasm such as perforation with abscess formation. MRI offers excellent tissue resolution which aids in distinguishing between localized colorectal disease and disease which invades muscle. Also, MRI can add information with coronal views for determining whether a sphincter-saving procedure can be performed, and may be of benefit for assessing the subtle extent of tumour into muscle and bone. However, CT and MRI lack the ability to assess depth of neoplastic involvement within bowel wall. This limitation is the major factor which, combined with the inability to diagnose metastatic tumour foci in normal-sized nodes and microinvasion of perirectal fat, prevents optimal tumour staging. Because of the low accuracy for assessing early cancer stages, neither CT nor MRI are recommended for routine use in preoperative staging. CT and MRI have a premier role in the assessment of recurrent colorectal neoplasm, with CT providing a slightly better overall evaluation due to volume imaging, easy image reconstructions in different planes, and availability of excellent oral and intravenous contrast agents. Cross-sectional imaging is the only method to evaluate fully patients with total AP resection, particularly male patients. Neither CT nor MRI can determine with certainty that a soft tissue density in the surgical bed following total AP resection represents recurrent tumour unless a clear mass is present which has increased in size over time. However, both methods surpass colonoscopy for detecting early mass-like tumour recurrence at the anastomotic site due to its extrinsic component. Cross-sectional imaging plays a prominent role in assessing inflammatory disease of the colon. Clinical history, laboratory data and extent of involvement are used together with results from radiographic examinations to reach a specific diagnosis. CT is preferred over MRI in the assessment of extent of inflammatory disease in and beyond the bowel wall. An additional benefit of CT over MRI is the fact that patients with abscesses or large fluid collection can undergo drainage while still in the CT scanner. CT and MRI can aid in the distinction between ulcerative colitis with minimal wall-thickening and Crohn's disease with marked wall-thickening combined with skip lesions and fistula and/or abscess formation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Current CT/MRI examination of the lower intestinal tract. 774 75

Sacroiliitis is usually the first and main feature of seronegative spondyloarthropathies. In its early stages it is difficult for diagnostic imaging techniques to demonstrate it and specificity is poor. At the same time, there may be few or even no symptoms at all. Therefore, the anatomical damage is quite often diagnosed at an advanced and irreversible stage. This study was aimed at assessing sacroiliac joint impairment during seronegative arthritis by means of diagnostic imaging techniques. The abnormal features of this condition are reported, pointing out the different findings of ankylosing spondylitis, psoriatic arthritis, Reiter's disease, reactive arthritis and sacroiliitis associated with chronic enteritis--e.g., Crohn's disease, ulcerative colitis, etc. Then, the capabilities and the features of each imaging method (conventional radiology, CT, bone scan, MRI) are reported. Modern techniques are dealt with in depth, especially relative to their capabilities in solving radiographic dilemmas. Technological progress is currently focused on MRI, whose use in early inflammatory sacroiliitis during seronegative spondyloarthropathies remains however in the experimental stage. Therefore, plain radiography is still the method of choice and its findings are used as a diagnostic criterion in unquestionable cases. To conclude, if the peculiar morphologic features of this condition are known and supported by clinical and radiographic findings, the condition can be diagnosed early, which means proper treatment and a lower incidence of highly invalidating sequelae.
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PMID:[Sacroiliitis in seronegative arthritis. The anatomicopathological aspects and imaging methods compared]. 793 22

The etiology and pathogenesis of idiopathic chronic-inflammatory bowel diseases, i.e. Crohn's disease and ulcerative colitis, are still unknown. This has no effect on diagnosis, yet does affect treatment of these diseases, which has thus remained symptomatic. Clinical features, laboratory findings, endoscopy in conjunction with histologic examination and radiologic studies are all of proven value in the diagnosis of these disorders. Microbiologic and, if indicated, serologic studies are employed to search for colitis caused by microorganisms. Other bowel disorders to be considered in differential diagnosis include ischemic, radiation and drug-induced forms of colitis, as well as diverticulitis. More recently introduced techniques for the detection of secondary intra-abdominal processes are CT-scan and MRI (magnetic resonance imaging). Ultrasound examination of the abdomen can be used to search for thickening of the bowel wall. Use of the rather complicated hydrocolon sonography is rarely necessary. Endo-sonography is an established method for exploration of the rectum and is particularly useful for the detection of abscesses. The role of this technique in the diagnosis of colon processes remains to be determined. Studies using radiolabeled leukocytes are of theoretical interest but not usually required in the routine work-up of such patients. The same is true of chemical analyses of the feces and testing for antineutrophil cytoplasmic antibodies. Standard systemic treatment is based on the administration of salicylic acid derivatives and corticosteroids. Azathioprine and 6-mercaptopurine can be used in patients refractory to standard treatment. Metronidazole has been proven quite effective in patients with Crohn's disease of the colon, particularly in the perianal region.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Current developments in the diagnosis and therapy of Crohn disease and ulcerative colitis]. 814 28

Three normal volunteers and 20 patients with known Crohn's disease were examined with MRI--at 0.5 Tesla and with a superconductive magnet. Coronal T1-weighted GE images were mainly acquired, before and after i.v. Gd-DTPA injection in breath hold (TR 70 ms, TE 13 ms, FA 70 degrees). MR findings were compared with the results of small and large bowel enema. In 6 patients (30%) the abnormal loops were missed. In the other 14 patients (70%) MRI did depict the affected loops in the same sites as depicted by conventional radiography. The bowel wall was thickened (4-10 mm) in all patients. In 10 patients the thickened wall was markedly enhanced after Gd-DTPA injection. In 6 patients MRI demonstrated disease complications--i.e., stenoses, fistulae and abscesses--missed by conventional radiography. In 7 patients MRI showed the bowel to be more involved than demonstrated by conventional studies. Bowel wall thickening appeared to be a constant and reliable sign of disease. Wall enhancement was a less frequent sign but, when present, it was considered as characteristic as wall thickening. In the staging of Crohn's disease, MRI yields more pieces of information than conventional radiography and depicts the involvement of the intestinal wall and of its surrounding spaces.
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PMID:[Magnetic resonance imaging of the small intestine and colon in Crohn's disease]. 861 37

Perianal disease occurs in up to 90% of patients with Crohn's disease [1-4]. Many of these patients have only mild symptoms or are asymptomatic and thus require no intervention. Clinical features are variable and include hypertrophic skin tags, ulceration, perianal abscess and fistulae, anal canal ulcers, fissures, induration and stenosis. Perianal abscess and fistula often occur simultaneously and are usually symptomatic. Symptoms range from pain, discharge, bleeding, to gross faecal incontinence with restriction of lifestyle and sexual activity. There is little uniformity amongst clinicians in the investigation and management of perianal Crohn's disease [5]. This is due, in part, to the variability in both frequency and severity of attacks and to spontaneous remissions and exacerbations of perianal disease. Secondly, assessment of severity of illness and the response to treatment is difficult to objectively quantitative. Improvement in quality of life is the aim of therapy not cure of perianal disease. Investigative modalities for perianal Crohn's are changing due to the limitations of conventional fistulography, CT scanning and clinical evaluation. MRI scanning has been introduced more recently, however, requires an endorectal coil to obtain good anatomical visualisation and has limited availability [6-12]. Endorectal ultrasonography has been shown to detect more abscesses and fistula in Crohn's patients than clinical examination, proctosigmoidoscopy and CT scanning, better delineation of fistulous tracts than fistulography and has the ability to change the clinical management of referring physicians [13-16]. Most fistulae are not explored surgically and therefore the documentation of fistulae in symptomatic Crohn's disease has been limited and are usually classified only as high or low [4]. Park's has pointed out this terminology for cryptoglandular disease is "... an ambiguous one" and hence developed a more precise nomenclature [17]. The objective of this study was to document prospectively by transanorectal ultrasonography fistulae and abscesses in symptomatic perianal Crohn's disease and to classify them according to Park's nomenclature and determine the incidence of these at the time of referral for a new exacerbation of the disease. Anal wall thickness was measured prospectively by ultrasonography as it has been shown to be increased in patients with perianal Crohn's disease and may reflect disease activity [13, 18].
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PMID:Fistulae and abscesses in symptomatic perianal Crohn's disease. 895 12

A patient with active Crohn disease was evaluated by MRI at admission, clinical remission, and a new relapse. The MRI-estimated disease extension correlated with surgical findings, whereas ultrasonography underestimated and a small bowel series overestimated the extension. MRI disclosed the disappearance of intestinal edema at the time of clinical remission and, in contrast to ultrasonography, showed an abscess and a fistula, confirmed by surgery, at the new relapse.
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PMID:Magnetic resonance imaging of Crohn disease: early recognition of treatment response and relapse. 901 26

A 35-year-old man treated for a Crohn's disease presented with a second facial palsy in a setting of recurrent labial edema known since childhood. The diagnosis of Melkerson-Rosenthal syndrome was established. MRI showed a small T1 gadolinium-enhanced lesion of the facial nerve suggesting an inflammatory process. Similarities of pathologic lesions found in Melkerson-Rosenthal syndrome, Crohn's disease and sarcoidosis raise the question of the relationships between these disorders.
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PMID:[Magnetic resonance imaging of the facial nerve in a case of Melkerson-Rosenthal syndrome]. 977 77

In patients with inflammatory bowel disease (IBD), radiologic examinations are important for diagnosis and treatment. With conventional X-ray examinations, mucosal abnormalities, ulcers and fistulas can be visualised, but no information on the extramural extension of the disease can be obtained. Newer radiologic modalities (ultrasound, CT and MRI) offer new diagnostic possibilities. With ultrasound IBD can be diagnosed with good confidence and it can differentiate between Crohn's disease and ulcerative colitis. CT and MRI are indicated not so much to diagnose the disease but rather to determine the severity and spread of disease activity (transmural and extramural inflammation) and to detect complications such as fistulas and abscesses.
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PMID:[Unconventional imaging techniques in inflammatory bowel diseases]. 986 78

Most surgeons think of psoas abscesses as a very rare condition related to tuberculosis of the spine, but in contemporary surgical practice they are more usually a complication of gastrointestinal disease. A case note study was undertaken on all patients treated for psoas abscess at two large hospitals in the mid-Trent region over a 2-year period. All seven patients presented with pyrexia, psoas spasm, a tender mass and leucocytosis. The diagnosis was made on abdominal radiographs in one patient, CT scan in three, MRI in two, and ultrasound in one. Aetiological factors included Crohn's disease in three, appendicitis in two, and sigmoid diverticulitis and metastatic colorectal carcinoma in one each. Six patients underwent transabdominal resection of the diseased bowel, retroperitoneal debridement and external drainage of the abscess cavity. Percutaneous drainage was performed in one. Two patients had more than one surgical exploration for complications. There were no deaths and the hospital stay ranged from 8-152 days. Psoas abscess can be a difficult and protracted problem. Bowel resection, thorough debridement, external drainage and concomitant antibiotics are essential for psoas abscesses complicating gastrointestinal disease. Defunctioning stomas may be necessary. However, in some cases a multidisciplinary approach may be required, as psoas abscesses can involve bone and joints.
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PMID:Psoas abscesses complicating colonic disease: imaging and therapy. 1064 82

Anorectal fistulas don't follow the same rules as idiopathic anorectal fistulas do. Their cause and treatment is completely different. Almost 40% of all patients suffering from Crohn's disease show anorectal manifestations. In 10-15% of the cases the anorectal manifestation is the first sign of Crohn's disease at all. 30% of all fistulas heal at least for a while spontaneously. The diagnostic procedures include nowadays anal endosonography and MRI as most sensitive ones and should be added for every work-up of anorectal Crohn. We differ a conservative from a radical therapy. To our opinion every therapy should be adopted to the individual needs of each patient. The most important principle in anorectal Crohn's disease is laying open of the fistula tract and excision of all the diseased tissue. This should be followed either by a drainage seton or by a definitive plastic closure of the fistula (mucosa-muscle flap). For a mucosa-muscle-flap there is only in otherwise disease-free patients and there only for high transsphincteric fistulas an indication. In our own series we treated of 69 patients 59 with a drainage seton and 10 with a mucosa-muscle flap. Recurrence occurred in 6/59 respectively 2/10 of the treated patients. Anovaginal fistulas should due to the high recurrence rate of surgically closed fistulas (> 50%) only be operated if there are serious symptoms such as recurrent vaginal infection, vaginal flatus and permanent vaginal defecations.
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PMID:[Anorectal fistulas in Crohn disease]. 1054 73


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