Small bowel MR enterography: problem solving in Crohn’s disease

Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn’s disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition

Medical prevention of postoperative recurrence of Crohn\u2019s Disease: The state of the art

Post operative recurrence (POR) is for both patient and treating physician one of the most frustrating complications of Crohn\u2019s disease (CD). Conventional medications have been proven of little benefit to prevent POR. By contrast, anti-TNF agents do appear very effective to prevent this complication. Likely, their use may completely change the management paradigm of POR itself and of the native disease as well. Here we will briefly review the definition, the main modalities of diagnosis and the risk factors for POR. We will then focus on the various medications and approaches used to prevent POR and on possible long term strategies. We will then propose a potential algorithm and discuss some of the current open issues to prevent POR