0:00

So really briefly, we'll do a couple of quick

0:03

slides on Crohn's disease and why we use MR

0:06

enterography when we're looking at Crohn's disease.

0:09

So Crohn's is an idiopathic autoimmune disorder.

0:13

It can, of course, involve any portion of

0:15

the GI tract, and it's typically involving

0:18

segmental regions of the GI tract.

0:20

Much of the GI tract these days is evaluated

0:22

endoscopically, so you can look through the entire

0:25

colon and even part of the terminal ileum, as well as the stomach,

0:28

duodenum, and up into the very proximal jejunum.

0:31

But that mid portion between the proximal

0:33

jejunum and the terminal ileum is very

0:36

hard for the endoscopist to look at.

0:38

And so they're left with, you know, capsule endoscopy,

0:41

which provides some pictures through the region,

0:44

or imaging such as CT and MRI.

0:48

And more and more gastroenterologists

0:50

are realizing that MRI and CT really

0:53

are needed to fill out the whole picture.

0:55

There are lots of cases of Crohn's disease that can

0:58

have skip lesions or lesions that don't involve

1:01

the TI (Terminal ileum) or other areas that

1:05

they can typically see with their endoscopes.

1:07

And that's where MR enterography

1:09

really has its main role.

1:10

So, for one thing, it's used frequently at diagnosis.

1:14

Oftentimes, disease is suspected or

1:16

established after colonoscopy or endoscopy,

1:18

not always, but oftentimes. And to

1:21

really fill out and get the full extent

1:23

of the disease burden, CT or MR enterography is needed.

1:26

It can both be used to exclude small bowel disease

1:27

35 00:01:30,815 --> 00:01:35,565 as well as find complications that are

1:35

really important for managing these cases.

1:38

You know, surgeons really hate removing colons

1:40

in patients that they thought had a diagnosis

1:43

of UC, but in the end it turns out they have

1:45

Crohn's disease because they won’t make

1:47

patients better and they'll make them worse

1:49

when they try to give them an ileoanal pouch.

1:53

So small bowel disease can be seen in

1:55

over half of Crohn's patients, even with

1:58

negative TI (terminal ileum) on ileocolonoscopy.

2:00

And so these terminal ileum skipping type cases are the

2:03

cases where they really rely on us with CT and MRI

2:07

to fully understand their Crohn's disease.

2:11

In addition to the diagnosis piece, there's a lot of

2:14

interest in using MRI for monitoring treatment.

2:17

So gastroenterologists need to track the severity

2:20

of inflammation in order to decide which drugs are

2:22

working and when to increase dosage or back off.

2:27

So, the symptoms really don't correlate very well

2:30

with endoscopic disease activity and they also

2:33

don't correlate well with the biologic activity

2:35

of Crohn's disease.

2:36

Capsule endoscopy can sometimes be helpful, but it can

2:39

really miss a lot of segments, and that's

2:41

why they need enterography to help them.

2:45

So the decision to change drugs depends heavily

2:48

on disease activity, and increasingly this is more

2:51

and more cost-effective to perform enterography.

2:54

The biologics that these patients are on can cost

2:56

thousands of dollars per dose. If they hold off on

3:00

giving some patients biologics, it's not only better

3:03

care for the patient, but it saves a lot of money.

3:05

And so MR enterography, despite being

3:08

thought of as an expensive exam, is truly

3:11

cost-effective in managing these patients.

3:13

And so that's important to emphasize when

3:15

you talk to your providers about using more

3:17

enterography if they haven't been using it very much.