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

The two major inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), represent clinicopathologic entities that traditionally have been diagnosed on the basis of a combination of clinical, radiologic, endoscopic, and histologic features. The presence of an inflammatory syndrome associated with typical clinical manifestations must lead to perform endoscopic examinations. Ileocolonoscopy plays an integral role in establishing the diagnosis, excluding other etiologies, distinguishing Crohn's disease from ulcerative colitis, defining the patterns, extent, and activity of mucosal inflammation, and obtaining mucosal tissue for histologic evaluation of inflammatory bowel disease. Small bowel follow through is still a major examination. However, the role of CT and MRI (using enteroclysis) in the imaging of inflammatory bowel disease has also increased in importance. Capsule endoscopy could be a valuable diagnostic tool in patients with suspected Crohn's disease that has not been confirmed using standard imaging techniques. Serum perinuclear antineutrophil cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) have recently been added to our diagnostic armamentarium. Serology may prove to be useful in predicting the evolution of indeterminate colitis. Substantial progress could come from the improving of serologic and genetic tests in the future.
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PMID:[Diagnostic tools in inflammatory bowel diseases]. 1605 68

Infliximab, a chimeric monoclonal antibody, is a TNF-a inhibitor approved for use in refractory rheumatoid arthritis and Crohn s disease. We present the case of a patient affected by severe rheumatoid arthritis who was successfully treated with infliximab. She suffered diverse neurological complications: brachial plexitis, asymptomatic thoracic myelitis with extensive lesions in MRI study, and herpes zoster lumbar plexitis. We review the neurological adverse effects of infliximab (aseptic meningitis, opportunistic germs infections, disseminated herpes zoster) and focus in their potential adverse effect to induce central and peripheral nervous system demyelination.
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PMID:[Brachial plexitis and myelitis and herpes-zoster lumbar plexus disorder in patient treated with infliximab]. 1616 82

Anal ultrasound has demonstrated to be accurate in staging perianal cryptoglandular fistulae and fistulae in Crohn's disease. When there is an external fistula opening, H2O2 can be introduced with a plastic infusion catheter. The tract becomes then visible as a hyperechoic lesion ('white'). It has been shown that this corresponds excellent with surgical findings. It is equally sensitive as endoanal MRI. Because recurrent cryptoglandular fistulae are complex in about 50% and Crohn's fistula in 75%, it is mandatory to perform anal ultrasound preoperative in these patients to avoid missed tracks during surgery and subsequent recurrences. Anal ultrasound can also be used to monitor (medical) therapy in patients with Crohn's disease. Especially considering the easiness of performing and lesser costs then MRI, endoanal ultrasound merits more attention.
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PMID:Endoanal ultrasound in perianal fistulas and abscesses. 1662 17

This was a prospective comparison of dynamic MRI (1.5 T) and echo-signal enhanced ultrasound in evaluating vascularization in thickened bowel walls cases of Crohn's disease. Twenty-one patients with histologically confirmed Crohn's disease and bowel wall diameters >5 mm were examined by MRI and ultrasound (US). MR sequences: T1w fl2D, T2w, FLASH T1w post-contrast media (CM) applications with fat saturation were used. Dynamic Turbo-FLASH T1w sequences were acquired in the area of maximal thickening of the ileal wall every 1.5 s post-CM application for a total duration of 1 min. US was performed after the application of 1.2 ml of echo-signal enhancer. Contrast uptake was measured by the semiquantitative score and brightness analysis in regions of interest (ROI). Clinical and laboratory findings including Crohn's disease activity indices were documented; MRI and US parameters were correlated. The length of sonographically documented lesions (122+/-75 mm) correlated significantly with the length of thickened bowel segments in MRI (128+/-76 mm; r=0.466; P=0.033). The maximum percent signal enhancement in the terminal ileum at ultrasound (217.5+/-100.1%) showed a high correlation with the findings of MRI (262+/-108%; r=0.623; P=0.003). With both methods, a plateau phase was observed. US and MRI are capable of evaluating local vascularization in the bowel wall objectively.
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PMID:Evaluating bowel wall vascularity in Crohn's disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. 1675 51

A 32-year-old male patient presented in the emergency department of our hospital with acute vomiting and diarrhoea. He reported occasional non-severe diarrhoea over several years in the past. Furthermore, at the time of presentation the patient had had anuria for several days. A prerenal and postrenal origin of the renal failure was excluded. A renal biopsy was performed and histopathological examination displayed findings consistent with a haemolytic-uraemic syndrome but no signs of glomerulonephritis. MRI examination of the small bowel revealed inflammatory alterations typical for Crohn's disease, even without histological verification. We describe haemolytic-waemic syndrome as manifestation of Crohn's disease for the first time.
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PMID:[A 32-year-old patient with diarrhoea and acute kidney failure]. 1761 97

MRI is accepted as one of the major diagnostic tools for the detection of anorectal fistulas and abscesses. Noninvasiveness and high accuracy are advantageous hallmarks of this technique. In general, the purpose of imaging anal fistulas is to reduce the risk of recurrence, incontinence and non-healing. To achieve these goals, the applied method must provide the proctologist with detailed information. In this context, MRI acts as a guide for surgeons to accurately plan fistula operations. Another aspect is the follow-up of conservatively treated patients with fistulizing Crohn's disease. In 2000, subtraction MR fistulography was introduced as new imaging technique. This review provides an overview of the entire spectrum of diagnostic modalities for anorectal fistulas with emphasis on subtraction MR fistulography.
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PMID:[MRI for the detection of anorectal fistulas]. 1713 70

MRI is an important imaging tool in evaluation of adult and pediatric patients with Crohn disease. Pelvic MRI, in particular, has become the method of choice to evaluate for perianal fistulas and associated complications of Crohn disease. MRI can define the extent and location of perianal fistulas and abscesses, as well as provide critical information for operative management. In this pictorial essay, we describe useful MRI techniques for evaluation of perianal complications in pediatric patients with Crohn disease. We review pertinent anatomy and illustrate typical examples of perianal fistulas with and without abscess. We show one case of clinically suspected perianal fistula that was actually a pilonidal sinus.
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PMID:Pelvic MRI in children with Crohn disease and suspected perianal involvement. 1718 Mar 66

Crohn's disease is a chronic, transmural inflammatory process of the gastrointestinal tract. It often affects the colon with the perianal area. The most common intestinal manifestations include external and/or internal fistulas and abscesses. Assessment of the activity of perianal fistulas in the course of Crohn's disease seems to be an important factor influencing therapeutic approach. Fistula's activity is evaluated by such methods as magnetic resonance imaging, anal ultrasound and examination under anaesthesia. Usefulness of imaging methods in the diagnosis of fistulas still remains to be defined.MRI is used to present a wide spectrum of perianal fistulazing Crohn's disease. Additionally, it is an important instrument revealing location, extent and severity of inflammation. It is also very helpful to detect clinically silent sepsis related to small, local inflammation. The most common method used in MR imaging to assess topography of a fistula's track, is Parks' classification.Clinical indications to MRI may include follow-up studies of a diagnosed disease, classification of fistulas' subtypes in the course of Crohn's disease, determination of the extent of fistulas' tracts and spread of an inflammatory process what can guide surgical procedures.
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PMID:Perianal fistulas in Crohn's disease: MRI diagnosis and surgical planning: MRI in fistulazing perianal Crohn's disease. 1733 76

Colonoscopy and Barium contrast studies continue to be the techniques of choice for the evaluation of mucosal lesions in Crohn's disease. However, these techniques have limited capacity for demonstrating the transmural and extramural extension of the disease. Although ultrasound, CT, and MRI cannot detect early lesions, these techniques satisfactorily show parietal and extraparietal changes caused by the disease, thus complementing the information provided in conventional studies. These three techniques enable the evaluation of the pathological segments, the presence of stenosis and dilatation, and extramural disease (fibrofatty proliferation, fistulae, phlegmons, and abscesses). This information is essential for classifying each patient into one of the three subtypes of Crohn's disease (inflammatory, stenotic, or fistulating). These techniques also enable the evaluation of signs that indicate inflammatory activity (hyperemia, wall enhancement, and increased mesenteric vascularization), and this information, together with the subtype, will determine the treatment. Ultrasound, CT, and MRI should be included in the complete evaluation of the patient with Crohn's disease, together with clinical examination, laboratory tests, and conventional imaging studies. We review the role of ultrasound, CT, and MRI in the diagnosis and evaluation of Crohn's disease, describing patient preparation and examination protocols, as well as the findings in these three techniques. We also discuss the advantages and limitations of each of these techniques and their current clinical roles in this context.
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PMID:[Ultrasound, CT, and MRI in Crohn's disease]. 1740 39

The aim was to compare bowel distension and diagnostic properties of magnetic resonance imaging of the small bowel with oral contrast (MRI per OS) with magnetic resonance enteroclysis (MRE). Forty patients with suspected Crohn's disease (CD) were examined with both MRI methods. MRI per OS was performed with a 6% mannitol solution and MRE with nasojejunal intubation and a polyethylenglycol solution. MRI protocol consisted of balanced fast field echo (B-FFE), T2 and T1 sequences with and without gadolinium. Two experienced radiologists individually evaluated bowel distension and pathological findings including wall thickness (BWT), contrast enhancement (BWE), ulcer (BWU), stenosis (BWS) and edema (EDM). The diameter of the small bowel was smaller with MRI per OS than with MRE (difference jejunum: 0.55 cm, p < 0.001; ileum: 0.35 cm, p < 0.001, terminal ileum: 0.09 cm, p = 0.08). However, CD was diagnosed with high diagnostic accuracy (sensitivity, specificity, positive and negative predictive values: MRI per OS 88%, 89%, 89%, 89%; MRE 88%, 84%, 82%, 89%) and inter-observer agreement (MRI per OS k = 0.95; MRE k = 1). In conclusion, bowel distension was inferior in MRI per OS compared to MRE. However, both methods diagnosed CD with a high diagnostic accuracy and reproducibility.
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PMID:A prospective randomized comparison between two MRI studies of the small bowel in Crohn's disease, the oral contrast method and MR enteroclysis. 1748 55


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