Because of radiation concerns about CT enterography, European researchers began developing MR enterography in the early 2000s as an alternative for pediatric patients. The first feasibility study was published in 2005.
A single CTE exam exposes the patient to about 4 mSv of radiation, though the effective dose can be much higher. A longitudinal European study found that 15% of Crohn's disease patients accumulated more than 75 mSv from radiological procedures in 15 years. The risk of high radiation exposure doubled for patients diagnosed with Crohn's disease before the age of 17 years (Gut, November 2008, Vol. 57:11, pp. 1524-1529).
The CTE protocol served as a natural template for MRE's development, with variations added to reflect individual preferences to capitalize on MRI's inherently higher contrast resolution.
The preferred agent for bowel distention during MR enterography varies from institution to institution, according to Dr. Michael Gee, PhD, an assistant professor of radiology at Massachusetts General Hospital (MGH) in Boston. Most radiologists use a neutral enteric agent, but some Europeans prefer polyethylene glycol (PEG).
Gee's group at MGH mix a neutral enteric agent mixed with an oral suspension of ultrasmall iron oxide particles. When mixed with water in the bowel, the mixture looks dark on T2-weighted MRI. Before MRE, an intravenous gadolinium-based contrast medium is injected to enhance extraluminal tissue.
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