Hafeez, R; (2012) Optimization and acceptance of enteric MRI in inflammatory bowel disease. Doctoral thesis , UCL (University College London).

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Abstract

Inflammatory bowel disease is a chronic inflammatory condition of bowel. CT and barium fluoroscopy are main stay of radiological investigation but impart high radiation dose. MRI is a safe and less invasive technique to assess bowel. The thesis examines the use of magnetic resonance Imaging in enteric inflammatory bowel disease. A discussion on inflammatory bowel disease and overview of MRI techniques, diagnostic features and review of literature is described. A national survey about the uptake of MRI for the investigation of IBD showed that 38% of radiology departments offered enteric MRI and barium studies remaining the main imaging investigation performed. A proforma administered to clinicians in OPD showed significant increase in their diagnostic confidence for small bowel disease after MRE, which had positive impact on therapeutic strategy of 61% of patients. The results of a prospective studies investigating MR colonography as a biomarker of disease activity are then presented. Quantitative measurements of contrast enhancement in normal colon have shown intersegmental differences. Three proposed qualitative MRI scores of disease activity correlated with endoscopic disease activity, but correlation with histopathological scores was less apparent. The use of unprepared colonic MRI in assessment of acute colitis is then investigated. A qualitative total colonic inflammation score (TCIS) proposed and validated against clinical standards including stool frequency and CRP. It also has prognostic ability for length of hospital stay. Region of interest derived quantitative measurements from the colon wall including T2 signal and contrast enhancement are then compared to a validated clinical score of colitis activity. Quantitative markers seemed less robust then qualitative scores, although quantified contrast enhancement is correlated with disease severity. Patient experiences of MR Colonography and colonoscopy are investigated by using face-to-face qualitative interviews, together with a quantitative questionnaire. Patient preference is highly complex but patients expressed overall preference for MRC.

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