Assessment of CrohnÕs disease activity in the small bowel with MR-enteroclysis: clinico-radiological correlations Roberto Malago `, 1 Riccardo Manfredi, 1 Luigi Benini, 2 Gianni DÕAlpaos, 1 Roberto Pozzi Mucelli 1 1 Department of Radiology, Policlinico ‘‘G.B. Rossi’’, University of Verona, P.le L.A.Scuro, 10, 37134, Verona, Italy 2 Department of Gastroenterology, Policlinico ‘‘G.B. Rossi’’, University of Verona, P.le L.A.Scuro, 10, 37134, Verona, Italy Abstract Background: The aim of our study was to evaluate the accuracy of magnetic resonance imaging (MRI) in evaluating CrohnÕs disease (CD) activity compared to clinical/laboratory data. Methods: Ninety-three consecutive patients with CD were prospectively studied by MR imaging, before and after Gadolinium chelates administration, with use of a biphasic endoluminal contrast agent. MR image analysis included: number of lesions, presence/absence of bowel stenosis, upstream bowel dilation, wall thickness, pres- ence of enhancement, enhancement pattern, presence/ absence of comb sign, lymph nodes, and perianal fistulas/abscesses. Clinical evaluation was performed by means of Harvey & Bradshaw Index. Acute-phase reactants were considered standard of reference to monitor biological activity (BA). MR imaging findings were compared with clinical and laboratory data. Results: MR image analysis detected: In 96 exams multiple lesions in 16, 1 in 50; no lesions in 30; stenosis in 52; dilatation in 28; wall thickening in 59; significant enhancement in 57; layered pattern in 50; comb sign in 37; enlarged lymph nodes in 16; fibro-fatty proliferation in 40; fistulas in 9. Conclusions: MRI is able to depict morphological changes and is helpful in assessing CrohnÕs inflammatory disease. Key words: Magnetic resonance imaging—CrohnÕs disease—CrohnÕs disease activity—MR enteroclysis—Clinico-radiological correlations CrohnÕs disease (CD) is a chronic inflammatory disease of the alimentary tract involving all the layers of the bowel wall that leads to fistulas, abscesses, and strictures. The disease lasts throughout the patientÕs lifetime; how- ever, the course of the disease is characterized by remit- ting and relapsing episodes. The assessment of the inflammatory activity of CD is important to identify patients with active inflammation so that medical therapy may be prescribed. Furthermore the presence of intense inflammatory activity may affect outcome or change the indications for surgery. Fur- thermore the advent of new medication, such as inflix- imab, an immunomodulatory drug with considerable side effects, follow-up to determine its efficacy is becoming increasingly important. Assessment of disease activity is based mainly on clinical parameters, requiring determination of CrohnÕs disease activity index (CDAI). Despite the fact that the CDAI is in part based on subjective criteria, it is widely used by most clinicians. Assessment of the disease activity is a major clinical problem and has important consequences for patient management [1–3]. Magnetic resonance imaging (MRI) has developed as the method of choice, complementary to ileo-colonos- copy and biopsy, for assessing presence/absence of bowel wall changes, their location, and their extent [4, 5]. Its ability to detect extramural complications such as ab- scess or fistulae is an added advantage. There are some initial works in the literature on the ability of MR Correspondence to: Roberto Malago`; email: rmalag@sirm.org; rober- tomalag@yahoo.it ª Springer Science+Business Media, LLC 2008 Published online: 29 January 2008 Abdominal Imaging Abdom Imaging (2008) 33:669–675 DOI: 10.1007/s00261-008-9368-8