MR Imaging of the Small Bowel

Published Online:https://doi.org/10.1148/radiol.12111658

MR enteroclysis should be recommended as the initial imaging examination in patients suspected of having inflammatory or neoplastic small-bowel diseases.

Small-bowel radiology has undergone dramatic changes in the past 2 decades. Despite important recent advances in small-bowel endoscopy, radiologic imaging remains important for patients suspected of having or with established small-bowel disease. Cross-sectional imaging techniques (computed tomography and magnetic resonance [MR] imaging), used to investigate both extraluminal abnormalities and intraluminal changes, have gradually replaced barium contrast examinations, which are, however, still used to examine early mucosal disease. MR imaging techniques clearly highlight endoluminal, mural and extramural enteric details and provide vascular and functional information, thereby enhancing the diagnostic value of these techniques in small-bowel diseases. Two MR imaging based techniques are currently utilized: MR enteroclysis and MR enterography. In enteroclysis, enteric contrast material is administered through a nasoenteric tube, whereas in enterography, large volumes of enteric contrast material are administered orally. MR enteroclysis ensures consistently better luminal distention than does MR enterography in both the jejunum and the ileum and more accurately depicts endoluminal abnormalities and early disease, particularly at the level of the jejunal loops. Moreover, MR enteroclysis provides a high level of accuracy in the diagnosis and exclusion of small-bowel inflammatory and neoplastic diseases and can be used for the first radiologic evaluation, while MR enterography may effectively be used to follow up both Crohn disease patients without jejunal disease and in pediatric patients where nasogastric intubation might be a problem. MR enteroclysis may also reveal subtle transition points or an obstruction in the lower small bowel, which may escape detection when more routine methods, including enterography, are used. MR imaging offers detailed morphologic information and functional data of small-bowel diseases and provides reliable evidence of normalcy, thereby allowing the diagnosis of early or subtle structural abnormalities and guiding treatment and decisions in patient care.

© RSNA, 2012

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111658/-/DC1

References

  • 1 Maglinte DD, Sandrasegaran K, Chiorean M, Dewitt J, McHenry L, Lappas JC. Radiologic investigations complement and add diagnostic information to capsule endoscopy of small-bowel diseases. AJR Am J Roentgenol 2007;189(2):306–312. Crossref, MedlineGoogle Scholar
  • 2 Kelvin FM, Maglinte DD. Enteroclysis or small bowel follow-through in Crohn’ s diseases? Gastroenterology 1998;114(6):1349–1351. Crossref, MedlineGoogle Scholar
  • 3 Maglinte DD, Kohli MD, Romano S, Lappas JC. Air (CO2) double-contrast barium enteroclysis. Radiology 2009;252(3):633–641. LinkGoogle Scholar
  • 4 Fraquelli M, Colli A, Casazza Get al.. Role of US in detection of Crohn disease: meta-analysis. Radiology 2005;236(1):95–101. LinkGoogle Scholar
  • 5 Fukumoto A, Tanaka S, Imagawa Het al.. Usefulness and limitations of transabdominal ultrasonography for detecting small-bowel tumors. Scand J Gastroenterol 2009;44(3):332–338. Crossref, MedlineGoogle Scholar
  • 6 Martínez MJ, Ripollés T, Paredes JM, Blanc E, Martí-Bonmatí L. Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI. Abdom Imaging 2009;34(2):141–148. Crossref, MedlineGoogle Scholar
  • 7 Maglinte DD, Sandrasegaran K, Lappas JC, Chiorean MCT. CT Enteroclysis. Radiology 2007;245(3):661–671. LinkGoogle Scholar
  • 8 Elsayes KM, Al-Hawary MM, Jagdish J, Ganesh HS, Platt JFCT. CT enterography: principles, trends, and interpretation of findings. RadioGraphics 2010;30(7):1955–1970. LinkGoogle Scholar
  • 9 Horsthuis K, Stokkers PC, Stoker J. Detection of inflammatory bowel disease: diagnostic performance of cross-sectional imaging modalities. Abdom Imaging 2008;33(4):407–416. Crossref, MedlineGoogle Scholar
  • 10 Furukawa A, Saotome T, Yamasaki Met al.. Cross-sectional imaging in Crohn disease. RadioGraphics 2004;24(3):689–702. LinkGoogle Scholar
  • 11 Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis 2004;10(1):45–54. Crossref, MedlineGoogle Scholar
  • 12 Maglinte DD, Bender GN, Heitkamp DE, Lappas JC, Kelvin FM. Multidetector-row helical CT enteroclysis. Radiol Clin North Am 2003;41(2):249–262. Crossref, MedlineGoogle Scholar
  • 13 Costamagna G, Shah SK, Riccioni MEet al.. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002;123(4):999–1005. Crossref, MedlineGoogle Scholar
  • 14 Leighton JA, Legnani P, Seidman EG. Role of capsule endoscopy in inflammatory bowel disease: where we are and where we are going. Inflamm Bowel Dis 2007;13(3):331–337. Crossref, MedlineGoogle Scholar
  • 15 Goldstein JL, Eisen GM, Lewis Bet al.. Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo. Clin Gastroenterol Hepatol 2005;3(2):133–141. Crossref, MedlineGoogle Scholar
  • 16 Maglinte DD. Capsule imaging and the role of radiology in the investigation of diseases of the small bowel. Radiology 2005;236(3):763–767. LinkGoogle Scholar
  • 17 Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. RadioGraphics 2009;29(6):1811–1825. LinkGoogle Scholar
  • 18 Wiarda BM, Kuipers EJ, Heitbrink MA, van Oijen A, Stoker J MR. Enteroclysis of inflammatory small-bowel diseases. AJR Am J Roentgenol 2006;187(2):522–531. Crossref, MedlineGoogle Scholar
  • 19 Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H. Small-bowel disease: comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 2000;215(3):717–725. LinkGoogle Scholar
  • 20 Gourtsoyiannis NC, Grammatikakis J, Papamastorakis Get al.. Imaging of small intestinal Crohn’s disease: comparison between MR enteroclysis and conventional enteroclysis. Eur Radiol 2006;16(9):1915–1925. Crossref, MedlineGoogle Scholar
  • 21 Prassopoulos P, Papanikolaou N, Grammatikakis J, Rousomoustakaki M, Maris T, Gourtsoyiannis N. MR enteroclysis imaging of Crohn disease. RadioGraphics 2001;21(Spec No):S161–S172. LinkGoogle Scholar
  • 22 Maglinte DD, Siegelman ES, Kelvin FM. MR enteroclysis: the future of small-bowel imaging? Radiology 2000;215(3):639–641. LinkGoogle Scholar
  • 23 Laghi A, Paolantonio P, Iafrate F, Altomari F, Miglio C, Passariello R. Oral contrast agents for magnetic resonance imaging of the bowel. Top Magn Reson Imaging 2002;13(6):389–396. Crossref, MedlineGoogle Scholar
  • 24 Rieber A, Aschoff A, Nüssle Ket al.. MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis. Eur Radiol 2000;10(9):1377–1382. Crossref, MedlineGoogle Scholar
  • 25 Small WC, DeSimone-Macchi D, Parker JRet al.. A multisite phase III study of the safety and efficacy of a new manganese chloride-based gastrointestinal contrast agent for MRI of the abdomen and pelvis. J Magn Reson Imaging 1999;10(1):15–24. Crossref, MedlineGoogle Scholar
  • 26 Kivelitz D, Gehl HB, Heuck Aet al.. Ferric ammonium citrate as a positive bowel contrast agent for MR imaging of the upper abdomen. Safety and diagnostic efficacy. Acta Radiol 1999;40(4):429–435. Crossref, MedlineGoogle Scholar
  • 27 Karantanas AH, Papanikolaou N, Kalef-Ezra J, Challa A, Gourtsoyiannis N. Blueberry juice used per os in upper abdominal MR imaging: composition and initial clinical data. Eur Radiol 2000;10(6):909–913. Crossref, MedlineGoogle Scholar
  • 28 Rieber A, Nüssle K, Reinshagen M, Brambs HJ, Gabelmann A. MRI of the abdomen with positive oral contrast agents for the diagnosis of inflammatory small bowel disease. Abdom Imaging 2002;27(4):394–399. Crossref, MedlineGoogle Scholar
  • 29 Schreyer AG, Gölder S, Scheibl Ket al.. Dark lumen magnetic resonance enteroclysis in combination with MRI colonography for whole bowel assessment in patients with Crohn’s disease: first clinical experience. Inflamm Bowel Dis 2005;11(4):388–394. Crossref, MedlineGoogle Scholar
  • 30 Fidler J. MR imaging of the small bowel. Radiol Clin North Am 2007;45(2):317–331. Crossref, MedlineGoogle Scholar
  • 31 Sood RR, Joubert I, Franklin H, Doyle T, Lomas DJ. Small bowel MRI: comparison of a polyethylene glycol preparation and water as oral contrast media. J Magn Reson Imaging 2002;15(4):401–408. Crossref, MedlineGoogle Scholar
  • 32 Laghi A, Carbone I, Catalano Cet al.. Polyethylene glycol solution as an oral contrast agent for MR imaging of the small bowel. AJR Am J Roentgenol 2001;177(6):1333–1334. Crossref, MedlineGoogle Scholar
  • 33 Lin MF, Narra V. Developing role of magnetic resonance imaging in Crohn’s disease. Curr Opin Gastroenterol 2008;24(2):135–140. Crossref, MedlineGoogle Scholar
  • 34 Gore R, Masselli G, Caroline D. Crohn’s disease of the small bowel. In: Gore R, Levine M, eds. Textbook of gastrointestinal radiology. 3rd ed. Philadelphia, Pa: Saunders Elsevier, 2008; 781–806. CrossrefGoogle Scholar
  • 35 Umschaden HW, Gasser J. MR enteroclysis. Radiol Clin North Am 2003;41(2):231–248. Crossref, MedlineGoogle Scholar
  • 36 Lauenstein TC, Schneemann H, Vogt FM, Herborn CU, Ruhm SG, Debatin JF. Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 2003;228(1):279–283. LinkGoogle Scholar
  • 37 Lomas DJ, Graves MJ. Small bowel MRI using water as a contrast medium. Br J Radiol 1999;72(862):994–997. Crossref, MedlineGoogle Scholar
  • 38 Ajaj W, Goyen M, Schneemann Het al.. Oral contrast agents for small bowel distension in MRI: influence of the osmolarity for small bowel distention. Eur Radiol 2005;15(7):1400–1406. Crossref, MedlineGoogle Scholar
  • 39 McKenna DA, Roche CJ, Murphy JMP, McCarthy PA. Polyethylene glycol solution as an oral contrast agent for MRI of the small bowel in a patient population. Clin Radiol 2006;61(11):966–970. Crossref, MedlineGoogle Scholar
  • 40 Kuehle CA, Ajaj W, Ladd SC, Massing S, Barkhausen J, Lauenstein TC. Hydro-MRI of the small bowel: effect of contrast volume, timing of contrast administration, and data acquisition on bowel distention. AJR Am J Roentgenol 2006;187(4):W375–W385. Crossref, MedlineGoogle Scholar
  • 41 Young BM, Fletcher JG, Booya Fet al.. Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr 2008;32(1):32–38. Crossref, MedlineGoogle Scholar
  • 42 Gourtsoyiannis NC, Papanikolaou N. Magnetic resonance enteroclysis. Semin Ultrasound CT MR 2005;26(4):237–246. Crossref, MedlineGoogle Scholar
  • 43 Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn’s disease in the small bowel: Prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 2006;16(12):2817–2827. Crossref, MedlineGoogle Scholar
  • 44 Zhu J, Xu JR, Gong HX, Zhou Y. Updating magnetic resonance imaging of small bowel: imaging protocols and clinical indications. World J Gastroenterol 2008;14(21):3403–3409. Crossref, MedlineGoogle Scholar
  • 45 Negaard A, Paulsen V, Sandvik Let al.. A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 2007;17(9):2294–2301. Crossref, MedlineGoogle Scholar
  • 46 Schreyer AG, Geissler A, Albrich Het al.. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2004;2(6):491–497. Crossref, MedlineGoogle Scholar
  • 47 Cronin CG, Lohan DG, Browne AM, Roche C, Murphy JM. Magnetic resonance enterography in the evaluation of the small bowel. Semin Roentgenol 2009;44(4):237–243. Crossref, MedlineGoogle Scholar
  • 48 Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Dose optimization of mannitol solution for small bowel distension in MRI. J Magn Reson Imaging 2004;20(4):648–653. Crossref, MedlineGoogle Scholar
  • 49 Lohan D, Cronin C, Meehan C, Alhajeri AN, Roche C, Murphy J. MR small bowel enterography: optimization of imaging timing. Clin Radiol 2007;62(8):804–807. Crossref, MedlineGoogle Scholar
  • 50 Masselli G, Casciani E, Polettini E, Gualdi G. Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 2008;18(3):438–447. Crossref, MedlineGoogle Scholar
  • 51 Korman U, Kurugoglu S, Ogut G. Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging. Abdom Imaging 2005;30(5):564–575. Crossref, MedlineGoogle Scholar
  • 52 Tolan DJ, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. RadioGraphics 2010;30(2):367–384. LinkGoogle Scholar
  • 53 Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P. MR enteroclysis: technical considerations and clinical applications. Eur Radiol 2002;12(11):2651–2658. Crossref, MedlineGoogle Scholar
  • 54 Cronin CG, Lohan DG, Mhuircheartaigh JNet al.. MRI small-bowel follow-through: prone versus supine patient positioning for best small-bowel distention and lesion detection. AJR Am J Roentgenol 2008;191(2):502–506. Crossref, MedlineGoogle Scholar
  • 55 Patak MA, von Weymarn C, Froehlich JM. Small bowel MR imaging: 1.5T versus 3T. Magn Reson Imaging Clin N Am 2007;15(3):383–393, vii. Crossref, MedlineGoogle Scholar
  • 56 Wiarda BM, Horsthuis K, Dobben ACet al.. Magnetic resonance imaging of the small bowel with the true FISP sequence: intra- and interobserver agreement of enteroclysis and imaging without contrast material. Clin Imaging 2009;33(4):267–273. Crossref, MedlineGoogle Scholar
  • 57 Leyendecker JR, Bloomfeld RS, DiSantis DJ, Waters GS, Mott R, Bechtold RE. MR enterography in the management of patients with Crohn disease. RadioGraphics 2009;29(6):1827–1846. LinkGoogle Scholar
  • 58 Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D. Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 2009;16(5):597–603. Crossref, MedlineGoogle Scholar
  • 59 Lauenstein TC, Ajaj W, Narin Bet al.. MR imaging of apparent small-bowel perfusion for diagnosing mesenteric ischemia: feasibility study. Radiology 2005;234(2):569–575. LinkGoogle Scholar
  • 60 Low RN, Sebrechts CP, Politoske DAet al.. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology 2002;222(3):652–660. LinkGoogle Scholar
  • 61 Sharman A, Zealley IA, Greenhalgh R, Bassett P, Taylor SA. MRI of small bowel Crohn’s disease: determining the reproducibility of bowel wall gadolinium enhancement measurements. Eur Radiol 2009;19(8):1960–1967. Crossref, MedlineGoogle Scholar
  • 62 Zappa M, Stefanescu C, Cazals-Hatem Det al.. Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 2011;17(4):984–993. Crossref, MedlineGoogle Scholar
  • 63 Taylor SA, Punwani S, Rodriguez-Justo Met al.. Mural Crohn disease: correlation of dynamic contrast-enhanced MR imaging findings with angiogenesis and inflammation at histologic examination—pilot study. Radiology 2009;251(2):369–379. LinkGoogle Scholar
  • 64 Masselli G, Polettini E, Casciani E, Bertini L, Vecchioli A, Gualdi G. Small-bowel neoplasms: prospective evaluation of MR enteroclysis. Radiology 2009;251(3):743–750. LinkGoogle Scholar
  • 65 Van Weyenberg SJ, Meijerink MR, Jacobs MAet al.. MR enteroclysis in the diagnosis of small-bowel neoplasms. Radiology 2010;254(3):765–773. LinkGoogle Scholar
  • 66 Maglinte DD, Lappas JC, Sandrasegaran K. Malignant tumors of the small bowel. In: Gore R, Levine M, eds. Textbook of gastrointestinal radiology. 3rd ed. Philadelphia, Pa: Saunders Elsevier, 2008; 853–869. CrossrefGoogle Scholar
  • 67 Low RN, Chen SC, Barone R. Distinguishing benign from malignant bowel obstruction in patients with malignancy: findings at MR imaging. Radiology 2003;228(1):157–165. LinkGoogle Scholar
  • 68 Masselli G, Picarelli A, Di Tola Met al.. Celiac disease: evaluation with dynamic contrast-enhanced MR imaging. Radiology 2010;256(3):783–790. LinkGoogle Scholar
  • 69 Gee MS, Harisinghani MG. MRI in patients with inflammatory bowel disease. J Magn Reson Imaging 2011;33(3):527–534. Crossref, MedlineGoogle Scholar
  • 70 Maccioni F, Bruni A, Viscido Aet al.. MR imaging in patients with Crohn disease: value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent. Radiology 2006;238(2):517–530. LinkGoogle Scholar
  • 71 Cronin CG, Delappe E, Lohan DG, Roche C, Murphy JM. Normal small bowel wall characteristics on MR enterography. Eur J Radiol 2010;75(2):207–211. Crossref, MedlineGoogle Scholar
  • 72 Sinha R, Verma R, Verma S, Rajesh A. MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 2011;197(1):80–85. Crossref, MedlineGoogle Scholar
  • 73 Maglinte DD, Gourtsoyiannis N, Rex D, Howard TJ, Kelvin FM. Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin North Am 2003;41(2):285–303. Crossref, MedlineGoogle Scholar
  • 74 Fletcher JG, Fidler JL, Bruining DH, Huprich JE. New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology 2011;140(6):1795–1806. Crossref, MedlineGoogle Scholar
  • 75 Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008;247(1):64–79. LinkGoogle Scholar
  • 76 Negaard A, Sandvik L, Mulahasanovic A, Berstad AE, Klöw NE. Magnetic resonance enteroclysis in the diagnosis of small-intestinal Crohn’s disease: diagnostic accuracy and inter- and intra-observer agreement. Acta Radiol 2006;47(10):1008–1016. Crossref, MedlineGoogle Scholar
  • 77 Froehlich JM, Waldherr C, Stoupis C, Erturk SM, Patak MA. MR motility imaging in Crohn’s disease improves lesion detection compared with standard MR imaging. Eur Radiol 2010;20(8):1945–1951. Crossref, MedlineGoogle Scholar
  • 78 Winship DH, Summers RW, Singleton JWet al.. National Cooperative Crohn’s Disease Study: study design and conduct of the study. Gastroenterology 1979;77(4 Pt 2):829–842. Crossref, MedlineGoogle Scholar
  • 79 Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet 1980;1(8167):514. Crossref, MedlineGoogle Scholar
  • 80 Koh DM, Miao Y, Chinn RJet al.. MR imaging evaluation of the activity of Crohn’s disease. AJR Am J Roentgenol 2001;177(6):1325–1332. Crossref, MedlineGoogle Scholar
  • 81 Rimola J, Rodriguez S, García-Bosch Oet al.. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 2009;58(8):1113–1120. Crossref, MedlineGoogle Scholar
  • 82 Del Vescovo R, Sansoni I, Caviglia Ret al.. Dynamic contrast enhanced magnetic resonance imaging of the terminal ileum: differentiation of activity of Crohn’s disease. Abdom Imaging 2008;33(4):417–424. Crossref, MedlineGoogle Scholar
  • 83 Madureira AJ. The comb sign. Radiology 2004;230(3):783–784. LinkGoogle Scholar
  • 84 Ziech ML, Bipat S, Roelofs JJet al.. Retrospective comparison of magnetic resonance imaging features and histopathology in Crohn’s disease patients. Eur J Radiol 2011;80(3):e299–e305. Crossref, MedlineGoogle Scholar
  • 85 Lawrance IC, Welman CJ, Shipman P, Murray K. Correlation of MRI-determined small bowel Crohn’s disease categories with medical response and surgical pathology. World J Gastroenterol 2009;15(27):3367–3375. Crossref, MedlineGoogle Scholar
  • 86 Masselli G. The gastrointestinal string sign. Radiology 2007;242(2):632–633. LinkGoogle Scholar
  • 87 Schmidt S, Chevallier P, Bessoud Bet al.. Diagnostic performance of MRI for detection of intestinal fistulas in patients with complicated inflammatory bowel conditions. Eur Radiol 2007;17(11):2957–2963. Crossref, MedlineGoogle Scholar
  • 88 Herrmann KA, Michaely HJ, Zech CJ, Seiderer J, Reiser MF, Schoenberg SO. Internal fistulas in Crohn disease: magnetic resonance enteroclysis. Abdom Imaging 2006;31(6):675–687. Crossref, MedlineGoogle Scholar
  • 89 Narin B, Ajaj W, Göhde Set al.. Combined small and large bowel MR imaging in patients with Crohn’s disease: a feasibility study. Eur Radiol 2004;14(9):1535–1542. Crossref, MedlineGoogle Scholar
  • 90 Schreyer AG, Rath HC, Kikinis Ret al.. Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 2005;54(2):250–256. Crossref, MedlineGoogle Scholar
  • 91 Horsthuis K, Bipat S, Stokkers PC, Stoker J. Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review. Eur Radiol 2009;19(6):1450–1460. Crossref, MedlineGoogle Scholar
  • 92 Cipriano LE, Levesque BG, Zaric GS, Loftus EV, Sandborn WJ. Cost-effectiveness of imaging strategies to reduce radiation-induced cancer risk in Crohn’s disease. Inflamm Bowel Dis 2011 Sep 16. doi: 10.1002/ibd.21862. [Epub ahead of print] MedlineGoogle Scholar
  • 93 Lee SS, Kim AY, Yang SKet al.. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 2009;251(3):751–761. LinkGoogle Scholar
  • 94 Siddiki HA, Fidler JL, Fletcher JGet al.. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 2009;193(1):113–121. Crossref, MedlineGoogle Scholar
  • 95 Schmidt S, Lepori D, Meuwly JYet al.. Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of “sign-by-sign” correlation. Eur Radiol 2003;13(6):1303–1311. Crossref, MedlineGoogle Scholar
  • 96 Soyer P, Boudiaf M, Fishman EKet al.. Imaging of malignant neoplasms of the mesenteric small bowel: new trends and perspectives. Crit Rev Oncol Hematol 2011;80(1):10–30. Crossref, MedlineGoogle Scholar
  • 97 Caspari R, von Falkenhausen M, Krautmacher C, Schild H, Heller J, Sauerbruch T. Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers’ syndrome. Endoscopy 2004;36(12):1054–1059. Crossref, MedlineGoogle Scholar
  • 98 Albert JG, Martiny F, Krummenerl Aet al.. Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 2005;54(12):1721–1727. Crossref, MedlineGoogle Scholar
  • 99 Semelka RC, John G, Kelekis NL, Burdeny DA, Ascher SM. Small bowel neoplastic disease: demonstration by MRI. J Magn Reson Imaging 1996;6(6):855–860. Crossref, MedlineGoogle Scholar
  • 100 Postgate A, Despott E, Burling Det al.. Significant small-bowel lesions detected by alternative diagnostic modalities after negative capsule endoscopy. Gastrointest Endosc 2008;68(6):1209–1214. Crossref, MedlineGoogle Scholar
  • 101 Baichi MM, Arifuddin RM, Mantry PS. Small-bowel masses found and missed on capsule endoscopy for obscure bleeding. Scand J Gastroenterol 2007;42(9):1127–1132. Crossref, MedlineGoogle Scholar
  • 102 Pennazio M, Rondonotti E, de Franchis R. Capsule endoscopy in neoplastic diseases. World J Gastroenterol 2008;14(34):5245–5253. Crossref, MedlineGoogle Scholar
  • 103 Estévez E, González-Conde B, Vázquez-Iglesias JL, Alonso PA, MdeL Vázquez-Millán, Pardeiro R. Incidence of tumoral pathology according to study using capsule endoscopy for patients with obscure gastrointestinal bleeding. Surg Endosc 2007;21(10):1776–1780. Crossref, MedlineGoogle Scholar
  • 104 Green PH, Cellier C. Celiac disease. N Engl J Med 2007;357(17):1731–1743. Crossref, MedlineGoogle Scholar
  • 105 Van Weyenberg SJ, Meijerink MR, Jacobs MA, van Kuijk C, Mulder CJ, van Waesberghe JH. MR enteroclysis in refractory celiac disease: proposal and validation of a severity scoring system. Radiology 2011;259(1):151–161. LinkGoogle Scholar
  • 106 Tomei E, Semelka RC, Braga Let al.. Adult celiac disease: what is the role of MRI? J Magn Reson Imaging 2006;24(3):625–629. Crossref, MedlineGoogle Scholar
  • 107 Lohan DG, Alhajeri AN, Cronin CG, Roche CJ, Murphy JM. MR enterography of small-bowel lymphoma: potential for suggestion of histologic subtype and the presence of underlying celiac disease. AJR Am J Roentgenol 2008;190(2):287–293. Crossref, MedlineGoogle Scholar
  • 108 Van Weyenberg SJ, Van Waesberghe JH, Ell C, Pohl J. Enteroscopy and its relationship to radiological small bowel imaging. Gastrointest Endosc Clin N Am 2009;19(3):389–407. Crossref, MedlineGoogle Scholar
  • 109 Beall DP, Fortman BJ, Lawler BC, Regan F. Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography. Clin Radiol 2002;57(8):719–724. Crossref, MedlineGoogle Scholar
  • 110 Lienemann A, Sprenger D, Steitz HO, Korell M, Reiser M. Detection and mapping of intraabdominal adhesions by using functional cine MR imaging: preliminary results. Radiology 2000;217(2):421–425. LinkGoogle Scholar

Article History

Received August 1, 2011; revision requested September 29; revision received January 17, 2012; accepted February 13; final version accepted February 23; final review by G.M. April 27.
Published online: Aug 2012
Published in print: Aug 2012