Crohn Disease: Schreyer AG

Hoffmann JC, Preiss JC, Autschbach F, Buhr HJ, Häuser W, Herrlinger K, Höhne W, Koletzko S, Krieglstein CF, Kruis W, Matthes H, Moser G, Reinshagen M, Rogler G, Schreiber S, Schreyer AG, Sido B, Siegmund B, Stallmach A, Bokemeyer B, Stange EF, Zeitz M. · Medizinische Klinik I, St. Marienkrankenhaus, Ludwigshafen. · Z Gastroenterol. · Pubmed #18810679 No free full text.

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Hoffmann JC, Autschbach F, Bokemeyer B, Buhr HJ, Herrlinger K, Höhne W, Krieglstein C, Kruis W, Moser G, Preiss JC, Reinshagen M, Rogler G, Schreiber S, Schreyer AG, Siegmund B, Stallmach A, Stange EF, Zeitz M. · Medizinische Klinik I, St. Marienkrankenhaus Ludwigshafen. · Dtsch Med Wochenschr. · Pubmed #18788069 No free full text.

This publication has no abstract.

Schreyer AG, Gölder S, Scheibl K, Völk M, Lenhart M, Timmer A, Schölmerich J, Feuerbach S, Rogler G, Herfarth H, Seitz J. · Department of Radiology, University Hospital Regensburg, Regensburg, Germany. · Inflamm Bowel Dis. · Pubmed #15803030 No free full text.

Abstract: BACKGROUND: Magnetic resonance enteroclysis (MRE) is a recently introduced imaging technique that assesses the small bowel with similar sensitivity and specificity as the fluoroscopically performed conventional enteroclysis. Magnetic resonance imaging colonography (MRC) seems to be a promising technique for polyp assessment in the colon. In this feasibility study, we evaluated the combination of small bowel MRI with unprepared MRC as an integrative diagnostic approach of the whole bowel in patients with Crohn's disease. METHODS: Thirty patients with known Crohn's disease were prospectively examined. No particular colonic preparation was applied. Applying the dark lumen technique in all patients, MRE and MRC were performed within 1 session using an integrative examination protocol. T2-weighted and contrast-enhanced T1-weighted sequences were acquired. Inflammation assessment (grades 0 to 2) of the colon was compared with conventional colonoscopy in 29 patient and with surgery in 1 patient. The entire colon was graded fair to good distended in all patients. In 11 of 210 evaluated colonic segments, feces hindered an adequate intraluminal bowel assessment. Twenty-three of 30 patients had complete colonoscopy as the gold standard. In 7 patients, complete colonoscopy could not be performed because of an inflamed stenosis. RESULTS: Correct grading of colonic inflammation was performed with 55.1% sensitivity and 98.2% specificity in all segments. Considering only more extensive inflammation (grade 2), the sensitivity of MRC increased to 70.2% with a specificity of 99.2%. CONCLUSIONS: The combination of MRE and MRC could improve the diagnostic value of abdominal MRI evaluation in patients with Crohn's disease. However, MRC can not replace conventional colonoscopy in subtle inflammation assessment.

Schreyer AG, Geissler A, Albrich H, Schölmerich J, Feuerbach S, Rogler G, Völk M, Herfarth H. · Department of Radiology, University of Regensburg, Germany. · Clin Gastroenterol Hepatol. · Pubmed #15181618 No free full text.

Abstract: BACKGROUND & AIMS: Diagnostic results of magnetic resonance (MR) enteroclysis correlate highly with those from conventional enteroclysis; nevertheless, intubation of the patient and positioning of an intestinal tube is still necessary for the examination, which is often remembered as the most embarrassing part of the examination by the patient. A more comfortable and highly sensitive examination of the small bowel therefore would increase patient acceptance for recurring examinations, which are often necessary, for example, in patients with Crohn's disease. This study evaluates the diagnostic efficacy of abdominal MR imaging (MRI) of the small bowel after drinking contrast agent only compared with conventional enteroclysis and abdominal MRI performed after enteroclysis in patients with suspected or proven Crohn's disease. METHODS: Twenty-one patients with Crohn's disease referred for conventional enteroclysis underwent abdominal MRI after enteroclysis. Additionally, 1 to 3 days before or after these examinations, abdominal MRI was performed using only orally administered contrast. All MRI examinations were performed using a 1.5T scanner. RESULTS: All pathological findings on conventional enteroclysis were shown correctly with MRI after enteroclysis and MRI after oral contrast only. Additional information by MRI was obtained in 6 of 21 patients. No statistically significant differences were found in assessing the diagnostic efficacy of the 3 examinations. CONCLUSIONS: Abdominal MRI with oral contrast only can be used as a diagnostic tool for evaluation of the small bowel in patients with Crohn's disease and has the potential to replace conventional enteroclysis as follow-up.

Gölder SK, Schreyer AG, Endlicher E, Feuerbach S, Schölmerich J, Kullmann F, Seitz J, Rogler G, Herfarth H. · Department of Internal Medicine I, University of Regensburg, 93042, Regensburg, Germany. · Int J Colorectal Dis. · Pubmed #15846497 No free full text.

Abstract: BACKGROUND AND AIMS: Small bowel MR enteroclysis and wireless capsule endoscopy (WCE) are new diagnostic tools for the investigation of the small bowel. The aim of this study was to compare the diagnostic yield of WCE with MR enteroclysis in the detection of small bowel pathologies. METHODS: A total of 36 patients were included in the study. Indications for imaging of the small bowel were proven or suspected small bowel Crohn's disease (CD; n=18), obscure gastrointestinal (GI) bleeding (n=14) and tumour surveillance (n=4). RESULTS: In patients with Crohn's disease WCE detected significantly more inflammatory lesions in the first two segments of the small bowel compared with MR enteroclysis (12 patients vs. 1 patient, p=0.016). In 5 out of 14 (36%) patients with GI bleeding, angiodysplasia was detected as a possible bleeding source. Three of these patients had active bleeding sites detected by WCE. One patient had scattered inflammation of the mucosa. MR enteroclysis did not reveal any intestinal abnormalities in this patient group. MR enteroclysis provided extraintestinal pathologies in 10 out of 36 (28%) patients. CONCLUSION: In patients with Crohn's disease WCE revealed significantly more inflammatory lesions in the proximal and middle part of the small bowel in comparison to MR enteroclysis, whereas in patients with obscure GI bleeding WCE was superior to MR enteroclysis.

Schreyer AG, Rath HC, Kikinis R, Völk M, Schölmerich J, Feuerbach S, Rogler G, Seitz J, Herfarth H. · Department of Radiology, University Hospital, Regensburg, 93042 Regensburg, Germany. · Gut. · Pubmed #15647190 links to  free full text

Abstract: AIM: Magnetic resonance imaging (MRI) based colonography represents a new imaging tool which has mainly been investigated for polyp screening. To evaluate this approach for patients with inflammatory bowel disease (IBD), we compared MRI based colonography with conventional colonoscopy for assessing the presence and extent of colonic inflammation. PATIENTS AND METHODS: In 22 consecutive patients with suspected or known IBD, MRI colonography was performed immediately before conventional colonoscopy. After bowel cleansing, a T1 positive contrast agent was applied rectally. In addition to T2 weighted sequences, T1 weighted two dimensional and three dimensional Flash acquisitions as well as volume rendered virtual endoscopy were performed. All images were evaluated with regard to typical MRI features of inflammation. The results were compared with colonoscopy findings. RESULTS: Distension and image quality was assessed as good to fair in 97.4% of all colonic segments. Only four of 154 segments were considered non-diagnostic. With colonoscopy serving as the gold standard, the sensitivity for correctly identifying inflammation on a per segment analysis of the colon was 31.6% for Crohn's disease (CD) and 58.8% for ulcerative colitis (UC). In CD, in most cases mild inflammation was not diagnosed by MRI while in UC even severe inflammation was not always depicted by MRI. Virtual endoscopy did not add any relevant information. CONCLUSION: MRI based colonography is not suitable for adequately assessing the extent of colonic inflammation in patients with IBD. Only severe colonic inflammation in patients with CD can be sufficiently visualised.

Schreyer AG, Herfarth H, Kikinis R, Seitz J, Schölmerich J, Geissler A, Feuerbach S. · Department of Radiology, University Hospital Regensburg, Germany. · Invest Radiol. · Pubmed #12218449 No free full text.

Abstract: RATIONALE AND OBJECTIVES: Small bowel MRI (MR imaging) is a new imaging modality that excellently depicts small intestine pathology in patients with inflammatory bowel disease. Virtual endoscopy based on sectional imaging is a recently introduced technique to create endoscopy like views. The aim of this study was to evaluate the feasibility of virtual small bowel endoscopy based on MR imaging in patients with Crohn disease. MATERIALS AND METHODS: Thirty consecutive patients with Crohn disease were scanned after oral application of pineapple juice for contrasting the small bowel. Dedicated high resolution T1 weighted 3D-FLASH sequences with fat suppression were used for volume scanning. Volume-rendered 3D models of the small bowel were created and virtual endoscopy was performed. The feasibility and quality of this new visualization method was assessed. RESULTS: In nine of 30 patients virtual endoscopy was considered as good quality (flight through the entire small bowel was possible, typical folds were revealed). In 18 patients fair quality (at least 4/5 of the small bowel were depicted adequately) was assessed. In three of 30 patients virtual endoscopy was not sufficiently possible because of inadequate bowel filling or breathing artifacts. Three fistulae diagnosed on 2D MRI were visualized on the virtual endoscopic view. CONCLUSION: Virtual endoscopy of the small bowel is feasible based on high resolution MR imaging. Vivid insight views and 3D models provide an interesting addition to sectional MR findings.