Answer
The usefulness in transmural assessment, the capability for sagittal imaging, and the lack of invasiveness are attractive features of MRI.
In a study by Shoenut and associates, MRI was comparable to endoscopy in differentiating ulcerative colitis from Crohn disease and in assessing the severity of disease. [25] In 17 of 18 patients, a correct diagnosis was made using gadolinium-enhanced, fat-suppressed, T1-weighted, spin-echo MRI. In 15 patients, a correct diagnosis was made on endoscopy. Overall, MRI was not significantly better than endoscopy in distinguishing ulcerative colitis from Crohn disease. MRI permitted correct grading of the severity of inflammatory changes in 13 of 20 patients; endoscopy did so in 11 cases. MRI and endoscopic findings were each found to be within one grade of the histologic findings in 7 patients. No significant difference was found between MRI and endoscopy in terms of the estimation of disease severity (as determined from biopsy samples). Assessments of bowel wall thickness on MRIs correlated well with the percentage of contrast enhancement. [25]
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Double-contrast barium enema study shows changes of early disease. Note the granular mucosa.
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Double-contrast barium enema studies show changes of early disease. Note the granular mucosa.
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Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. Images show total colitis and extensive pseudopolyposis.
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Plain abdominal radiograph in a patient (same as in the previous image) who presented with an acute exacerbation of his symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
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Plain abdominal radiograph obtained 2 days later in the same patient as in the previous image shows distention of the transverse colon associated with mucosal edema. The maximum transverse diameter of the transverse colon is 7.5 cm. The patient was treated for toxic megacolon.
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A 22-year-old man presented with abdominal pain, passage of blood and mucus per rectum, abdominal distention, fever, and disorientation. Findings from sigmoidoscopy confirmed ulcerative colitis. Abdominal radiographs obtained 2 days apart show mucosal edema and worsening of the distention in the transverse colon. The patient's clinical condition deteriorated over the next 36 hours despite steroid and antibiotic therapy, and the patient had to undergo total colectomy and ileostomy.
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Plain abdominal radiograph in a patient with known ulcerative colitis who presented with abdominal pain, peritonism, and leukocytosis. At surgery, a perforated toxic megacolon superimposed on ulcerative colitis was confirmed.
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Increased postrectal space is a known feature of ulcerative colitis.
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Plain abdominal radiograph on a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
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Double-contrast barium enema study shows pseudopolyposis of the descending colon.
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Single-contrast enema study in a patient (same patient as in the previous image) with known ulcerative colitis in remission shows a benign stricture of the sigmoid colon.
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Plain abdominal radiograph in a 26-year-old with a 10-year history of ulcerative colitis shows a long stricture/spasm of the ascending colon/cecum. Note the pseudopolyposis in the descending colon.
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Single-contrast enema study in a patient with total colitis shows mucosal ulcers with a variety of shapes, including collar-button ulcers, in which undermining of the ulcers occurs, and double-tracking ulcers, in which the ulcers are longitudinally orientated.
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Double-contrast barium enema study shows total colitis. Note the granular mucosa in the cecum/ascending colon and multiple strictures in the transverse and descending colon in a patient with a more than a 20-year history of ulcerative colitis.
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Single-contrast barium enema study shows burnt-out ulcerative colitis.
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Scan obtained with technetium-99m hexamethylpropylamine oxime (HMPAO)–labeled WBCs in a patient with active colitis involving the transverse and descending colon.
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Intravenous urogram shows features of ankylosing spondylitis.
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Lateral radiograph of the lumbar spine shows a bamboo spine.
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Single-contrast barium enema study in a patient with Shigella colitis.
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Postevacuation image obtained after a single-contrast barium enema study shows extensive mucosal ulceration resulting from Shigella colitis.
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Double-contrast barium enema studies show granular mucosa associated with Campylobacter colitis.
