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MRI in Crohn's disease—current and future clinical applications

Nature Reviews Gastroenterology & Hepatology volume 9, pages 23–31 (2012)Cite this article

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Abstract

Crohn's disease is a chronic, disabling disease that, over time, can lead to irreversible bowel damage. MRI can be used to diagnose and assess the activity, severity and complications of Crohn's disease; however, the role of MRI in therapeutic monitoring of changes in disease-related intestinal damage is still to be defined. Objective, validated MRI-based scores have been developed to assess the activity of Crohn's disease; these indices are based on the extent and severity of intestinal inflammation, postoperative recurrence and perianal disease. MRI is accurate, safe, reproducible and can allow repeated evaluations of patients without radiation exposure. Evidence that MRI might be valuable in the therapeutic monitoring of patients with Crohn's disease is increasing and, in combination with endoscopy and surgical history, this imaging technique could enable clinicians to assess Crohn's-disease-related intestinal damage. MRI could, therefore, have a crucial role in a future 'damage-driven' treatment paradigm—in which imaging is used to monitor intestinal damage and medication use is targeted to prevent the accumulation of further damage. This damage-driven therapeutic approach could potentially change the course of Crohn's disease.

Key Points

  • MRI is a useful tool to integrate with endoscopy in the diagnosis and follow-up of patients with Crohn's disease

  • Combining MRI findings and endoscopic examination results could provide detailed information on the presence and progression of bowel-wall involvement and extravisceral manifestations in patients with Crohn's disease

  • MRI can be used to assess the activity, severity and complications of Crohn's disease, and is a noninvasive method of detecting perianal disease, postoperative recurrence and fibrosis

  • Several objective MRI-based scores have been validated, which could be used to assess the response of patients with Crohn's disease to specific medications

  • MRI could have a crucial role in evaluating Crohn's-disease-related intestinal damage and monitoring the evolution of the disease

  • The use of MRI in therapeutic monitoring might change the treatment paradigm from a symptom-driven to a damage-driven approach, which could alter the course of the disease

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Figure 1: MRI scan from a patient with active luminal disease.
Figure 2: Coronal view in T1-weighted sequence fat-suppressed in one patient with fibrotic Crohn's disease.
Figure 3: Pelvic MRI scan from a patient with Crohn's disease and a perianal draining fistula.
Figure 4: MRI scan from a patient with postoperative recurrence of Crohn's disease.

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Change history

  • 09 December 2011

    In the version of this article initially published online references 50–52 were incorrectly cited in the section 'New MRI techniques and uses'. These references should have been 33, 79 and 80, respectively. The error has been corrected for the print, HTML and PDF versions of the article.

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  1. Division of Gastroenterology and Digestive Endoscopy, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Gionata Fiorino, Alberto Malesci & Silvio Danese

  2. Division of Radiology, Istituto Clinico Humanitas, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Cristiana Bonifacio & Luca Balzarini

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G. Fiorino researched the data for the article. G. Fiorino, C. Bonifacio, L. Balzarini and S. Danese contributed to the discussions of the article content. G. Fiorino and S. Danese wrote the manuscript. G. Fiorino, C. Bonifacio, A. Malesci and S. Danese undertook review and/or editing of the manuscript before submission.

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Correspondence to Silvio Danese.

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Fiorino, G., Bonifacio, C., Malesci, A. et al. MRI in Crohn's disease—current and future clinical applications. Nat Rev Gastroenterol Hepatol 9, 23–31 (2012). https://doi.org/10.1038/nrgastro.2011.214

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