Cross Sectional Imaging in Ileal Crohn’s Disease: Do We Need Magnetic Resonance Enterography after Computerized Tomography Affect Patient’s Care

Abstract Background: Cross-sectional imaging plays a crucial role in the diagnosis and management of ileal Crohn’s disease (CD). Although both computed tomography (CT) and magnetic resonance enterography (MRE) are used to evaluate disease extent, the utility of obtaining both studies in close succession remains uncertain. Objectives: To evaluate clinically relevant differences between CT and MRE findings when MRE is performed within 30 days of CT in patients presenting with an ileal Crohn’s flare. Design: Retrospective cohort study. Settings: Single tertiary referral inflammatory bowel disease center, between January 2012 and September 2016. Patient and Methods: A total of 144 consecutive patients underwent CT imaging followed by MRE within 30 days. Imaging studies were independently reviewed and categorized into disease subsets. Main Outcome Measure: Agreement between imaging modalities was assessed using Fleiss’ and Cohen’s kappa statistics. Sample Size: Ninety-five patients met the inclusion criteria. Results: In cases of chronic inactive and chronic active disease, CT and MRE findings demonstrated fair to moderate agreement (Fleiss’ kappa = 0.261 and 0.515, respectively). In cases of stricturing and penetrating disease, agreement was slight (kappa = 0.148 and 0.125, respectively). Conclusion: In patients with uncomplicated ileal CD, CT performed during an acute flare is generally sufficient for clinical decision-making, with limited additional value gained from subsequent MRE. Reducing redundant imaging may significantly lower healthcare costs. Prospective studies are warranted to validate a single-imaging strategy. Limitations: The study was limited by its retrospective design, potential bias introduced by radiologists having access to prior CT reports during MRE interpretation, its single-center setting, and the omission of analysis on the impact of imaging findings on subsequent clinical management decisions. Conflict of Interest None.