Both intestinal ultrasound and magnetic resonance imaging can assess radiologic stricturing in Crohn’s disease

1. Intestinal ultrasound (IUS) and magnetic resonance imaging (MRI) were effective imaging modalities for the assessment of the radiologic response of stricturing Crohn’s disease to treatment. 

Evidence Rating Level: 1 (Excellent)

In recent years, transmural healing has become a major treatment target in the management of Crohn’s disease. While such healing relies on imaging for assessment, there is a paucity of data examining the role of IUS in the monitoring of stricturing Crohn’s disease and time and cost remain significant barriers to access for MRI. This study, an analysis of secondary outcomes of the STRIDENT (Stricture Definition and Treatment) trial, therefore sought to investigate the role of MRI and IUS in monitoring the response of stricturing Crohn’s disease to treatment. 77 patients (median[IQR] age, 45[29-53] years) were included in the trial with all 77 receiving baseline IUS and MRI. Among baseline IUS scans, 59 were good quality with visible strictures. Among baseline MRIs, 72 had visible strictures. Stricture resolution on IUS occurred in 17/59 (29%) of patients, while stricture resolution on MRI occurred in 16/72 (22%) of patients. When comparing stricture resolution on IUS and MRI, there was a strong association (χ21(n = 59) = 41.19, Cramer’s V ϕ=0.84; P < .001). When comparing with endoscopy, there was a relatively strong association between stricture resolution on MRI and passable strictures visible on endoscopy (χ21(n = 64) = 10.54, Cramer’s V ϕ=0.41; P = .002). Overall, this study showed that MRI and IUS are effective imaging modalities in the assessment of the radiologic response of stricturing Crohn’s disease to treatment.  

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Image: PD

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