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Jan and others -

So, my doctors are still trying to determine if I have Crohns or UC before doing any surgeries - they just can't make up their mind. =( I recently had an MRI Enterography done to distinguish if I have Ulcerative Colitis or Crohns. What does this result mean? Is colonic wall thickening only seen in Crohns? Or it can be seen in Ulcerative Colitis as well? I have a couple of granulomas too which usually mean Crohns but GI doc says he is still not sure. I will be seeing doctor to review but thought I'd ask you all for your opinion beforehand. Thanks!!

There is diffused marked colonic wall thickening spanning from at least the rectum to the distal descending colon. There is hyperemia of the affected segement of bowel with associated intermediate T2 signal abnormality comnpatible with edema. No grossly apparent enhancing perirectal/pericolonic lymph nodes. No gross drainable fluid collection. Evaluation of the remainder of the colon is limited in part due to incomplete distention of the descending colon and moderate amount of stool retention within the transverse and ascending colon. Terminal ileum was not clearly visualized due to crowding of multiple bowel loops, and therefore it cannot be assessed. There is normal distention of the stomach with oral contrast which demonstrates a normal configuration. Findings compatible with diffuse active disease involving at least the rectum to the distal descending colon (proctocolitis), in this patient with known Ulcerative Colitis diagnosed on recent colonosocpy examination. No discrete drainable fluid collection. Unfortunately, evaluation of the remainder of the large and small bowel loops is limited and additional areas of disease involvement may exist but are not grossly apparent.
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Pkitty,

I'm going to be zero help here, but I also just had an MRE done to try to rule out Crohn's or determine why I was having obstructions. My results were "everything looks normal". Wish I had a little more information than that! I'm assuming I also have a write up, but it wasn't passed along to me. Hope they figure everything out for you. I'm still in the dark.
I am by no means any sort of authority or expert on interpreting imaging reports, but I understand a little. From what I read, it does not appear that there is any clear indication. You can have colonic bowel wall thickening with both Crohn's and UC (particularly with long standing, chronic UC). Higher degrees of thickening are associated with Crohn's, but I cannot tell if that is the case here. If this is Crohn's, it looks like Crohn's colitis, as there is no evidence of involvement outside the colon. No strictures or fistulas were identified, so that is good, but does not mean it is not Crohn's.

If the evidence weighs more toward a Crohn's colitis or indeterminate diagnosis, there are some surgeons who still consider j-pouch a viable surgical option, with the knowledge that there is an increased risk of complications or failure.

Your GI, who will be looking at the films, will be able to explain the nuances of the results. My other question would be if the slides from the granuloma biopsies were confirmed by a second pathologist. Everything I've read indicates that it is pretty close to the only truly diagnostic finding. Everything else is evidence tipping the balance one way or the other.

Good luck, and let us know what you find out.

Jan Smiler

Thanks Guys.  But, whan an MRI says, "diffuse marked colonic wall thickening spanning from at least the rectum to the distal descending colon" is that just MRI terminology for inflammation? Or does it mean that there is scarring and possible irreversible damage? My colonoscopies always said that all of my inflammation is superficial so I am confused if I am reading to much into the MRI wording or what?

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