MR enterography in Crohns disease and beyond: a pictorial review : Beyond Crohn's: a pictorial guide to MR enterography in small bowel disease
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This pictorial review illustrates and differentiates Magnetic Resonance Enterography findings of Crohn's disease and other small bowel pathologies that may simulate it, aiding radiologists in diagnosis.
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This pictorial review describes magnetic resonance enterography (MRE) as an imaging modality for small bowel disorders, focusing on Crohn’s disease (CD) and numerous conditions that can mimic CD’s MRE appearance. It compiles key MRE patterns and discusses potentially useful sequences while providing clinically relevant context across multiple “CD mimickers,” with an explicit caveat that it is a review/guide rather than new dataset generation or formal analysis. The main finding is an organized description of how different small bowel entities may present with overlapping imaging features and what imaging clues can help differentiate them. Relevance to endometriosis: the review includes gastrointestinal endometriosis as one of the mimickers discussed in the context of MRE findings in small bowel disease, though its main focus is CD and imaging differentiation of multiple inflammatory and non-inflammatory small bowel conditions.
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Abstract
Magnetic resonance enterography (MRE) has become an essential imaging modality for evaluating small bowel disorders, particularly Crohn's disease (CD), due to its superior soft-tissue contrast, multiplanar capabilities, and lack of ionizing radiation. While radiologists are generally familiar with the MRE findings of CD, several other small bowel entities can present with similar imaging features, potentially leading to diagnostic challenges. This pictorial review comprehensively illustrates the MRE findings of CD and its various mimickers, including Ulcerative colitis (UC), intestinal tuberculosis (ITB), Non-steroidal anti-inflammatory drug (NSAID) induced enteropathy, cryptogenic multifocal ulcerating and stenosing enteropathy (CMUSE), celiac disease, gastrointestinal endometriosis, intestinal lipomatosis, lymphangiectasia, eosinophilic enteritis, encapsulating peritoneal sclerosis, adhesions, radiation enteropathy, and intestinal angioedema etc. We discuss the key imaging features that can help a radiologist differentiate these conditions, highlight specific MRE sequences useful for diagnosis, and provide clinically relevant context for each entity. This review serves as a practical guide for radiologists and clinicians in recognizing and distinguishing various small bowel pathologies that may simulate CD on MRE, ultimately aiding in appropriate patient management.
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Abstract
Magnetic resonance enterography (MRE) has become an essential imaging modality for evaluating small bowel disorders, particularly Crohn’s disease (CD), due to its superior soft-tissue contrast, multiplanar capabilities, and lack of ionizing radiation. While radiologists are generally familiar with the MRE findings of CD, several other small bowel entities can present with similar imaging features, potentially leading to diagnostic challenges. This pictorial review comprehensively illustrates the MRE findings of CD and its various mimickers, including Ulcerative colitis (UC), intestinal tuberculosis (ITB), Non-steroidal anti-inflammatory drug (NSAID) induced enteropathy, cryptogenic multifocal ulcerating and stenosing enteropathy (CMUSE), celiac disease, gastrointestinal endometriosis, intestinal lipomatosis, lymphangiectasia, eosinophilic enteritis, encapsulating peritoneal sclerosis, adhesions, radiation enteropathy, and intestinal angioedema etc. We discuss the key imaging features that can help a radiologist differentiate these conditions, highlight specific MRE sequences useful for diagnosis, and provide clinically relevant context for each entity. This review serves as a practical guide for radiologists and clinicians in recognizing and distinguishing various small bowel pathologies that may simulate CD on MRE, ultimately aiding in appropriate patient management.
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References
Hovde Ø, Moum BA. Epidemiology and clinical course of Crohn’s disease: results from observational studies. World J Gastroenterol. 2012;18(15):1723–31. doi: https://doi.org/10.3748/wjg.v18.i15.1723. PMID: 22553396; PMCID: PMC3332285.
Desmond AN, O’Regan K, Curran C, McWilliams S, Fitzgerald T, Maher MM, Shanahan F. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut. 2008;57(11):1524–9. doi: https://doi.org/10.1136/gut.2008.151415. Epub 2008 Apr 28. PMID: 18443021.
Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;247(1):64–79. doi: https://doi.org/10.1148/radiol.2471070611. PMID: 18372465.
Siddiki H, Fidler J. MR imaging of the small bowel in Crohn’s disease. Eur J Radiol. 2009;69(3):409–17. doi: https://doi.org/10.1016/j.ejrad.2008.11.013. Epub 2008 Dec 31. PMID: 19118967.
Bruining DH, Zimmermann EM, Loftus EV Jr, Sandborn WJ, Sauer CG, Strong SA; Society of Abdominal Radiology Crohn’s Disease-Focused Panel. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease. Radiology. 2018;286(3):776–799. doi: https://doi.org/10.1148/radiol.2018171737. Epub 2018 Jan 10. PMID: 29319414.
Ordás I, Rimola J, Rodríguez S, Paredes JM, Martínez-Pérez MJ, Blanc E, Arévalo JA, Aduna M, Andreu M, Radosevic A, Ramírez-Morros AM, Pinó S, Gallego M, Jauregui-Amezaga A, Ricart E, Panés J. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn’s disease. Gastroenterology. 2014;146(2):374– 82.e1. doi: https://doi.org/10.1053/j.gastro.2013.10.055. Epub 2013 Oct 29. PMID: 24177375.
Sinha R, Murphy P, Sanders S, Ramachandran I, Hawker P, Rawat S, Roberts S. Diagnostic accuracy of high-resolution MR enterography in Crohn’s disease: comparison with surgical and pathological specimen. Clin Radiol. 2013;68(9):917–27. doi: 10.1016/j.crad.2013.02.012. Epub 2013 Apr 25. PMID: 23622798.
Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, Jairath V, Feagan BG, Rieder F; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68(6):1115–1126. doi: https://doi.org/10.1136/gutjnl-2018-318081. Epub 2019 Apr 3. PMID: 30944110; PMCID: PMC6580870.
Lambrou T, Chaudhry NA, Grajo JR, Moser P, Riverso M, Mramba LK, Zimmermann EM. Small bowel stricture is associated with abnormal motility on the cine MRI sequence in patients with Crohn’s disease. Eur J Radiol. 2019;118:264–270. doi: 10.1016/j.ejrad.2019.08.001. Epub 2019 Aug 2. PMID: 31439253.
Dohan A, Taylor S, Hoeffel C, Barret M, Allez M, Dautry R, Zappa M, Savoye-Collet C, Dray X, Boudiaf M, Reinhold C, Soyer P. Diffusion-weighted MRI in Crohn’s disease: Current status and recommendations. J Magn Reson Imaging. 2016;44(6):1381–1396. doi: https://doi.org/10.1002/jmri.25325. Epub 2016 Jun 1. PMID: 27249184.
Kaushal P, Somwaru AS, Charabaty A, Levy AD. MR Enterography of Inflammatory Bowel Disease with Endoscopic Correlation. Radiographics. 2017 Jan-Feb;37(1):116–131. doi: https://doi.org/10.1148/rg.2017160064. Epub 2016 Nov 25. PMID: 27885894.
Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR. A Practical Index to Distinguish Backwash Ileitis From Crohn’s Terminal Ileitis in MR Enterography. Inflamm Bowel Dis. 2023;29(1):42–50. doi: https://doi.org/10.1093/ibd/izac040. PMID: 35259254.
Radmard AR, Amouei M, Torabi A, Sima AR, Saffar H, Geahchan A, Davarpanah AH, Taouli B. MR Enterography in Ulcerative Colitis: Beyond Endoscopy. Radiographics. 2024;44(1):e230131. doi: https://doi.org/10.1148/rg.230131. PMID: 38127661.
Asare B, Huang C, Melia J, Fishman EK, Gawande R. Cross-sectional imaging of mimics of inflammatory bowel disease: not everything is Crohn’s disease or ulcerative colitis. Abdom Radiol (NY). 2025;50(1):8–23. doi: https://doi.org/10.1007/s00261-024-04436-z. Epub 2024 Jun 27. PMID: 38935092.
Sheedy SP, Bartlett DJ, Lightner AL, Trenkner SW, Bruining DH, Fidler JL, VanBuren WM, Menias CO, Reber JD, Fletcher JG. Judging the J pouch: a pictorial review. Abdom Radiol (NY). 2019;44(3):845–866. doi: https://doi.org/10.1007/s00261-018-1786-7. PMID: 30259096.
Choudhury A, Dhillon J, Sekar A, Gupta P, Singh H, Sharma V. Differentiating gastrointestinal tuberculosis and Crohn’s disease- a comprehensive review. BMC Gastroenterol. 2023;23(1):246. doi: https://doi.org/10.1186/s12876-023-02887-0. PMID: 37468869; PMCID: PMC10354965.
Kedia S, Das P, Madhusudhan KS, Dattagupta S, Sharma R, Sahni P, Makharia G, Ahuja V. Differentiating Crohn’s disease from intestinal tuberculosis. World J Gastroenterol. 2019;25(4):418–432. doi: https://doi.org/10.3748/wjg.v25.i4.418. PMID: 30700939; PMCID: PMC6350172.
Krishna S, Kalra N, Singh P, Kochhar R, Gupta R, Singh R, Khandelwal N. Small-Bowel Tuberculosis: A Comparative Study of MR Enterography and Small-Bowel Follow-Through. AJR Am J Roentgenol. 2016;207(3):571–7. doi: https://doi.org/10.2214/AJR.15.15580. Epub 2016 Jun 24. PMID: 27341543.
Frye JM, Hansel SL, Dolan SG, Fidler JL, Song LM, Barlow JM, Smyrk TC, Flicek KT, Hara AK, Bruining DH, Fletcher JG. NSAID enteropathy: appearance at CT and MR enterography in the age of multi-modality imaging and treatment. Abdom Imaging. 2015;40(5):1011-25. doi: https://doi.org/10.1007/s00261-015-0367-2. PMID: 25666969.
Flicek KT, Hara AK, De Petris G, Pasha SF, Yadav AD, Johnson CD. Diaphragm disease of the small bowel: a retrospective review of CT findings. AJR Am J Roentgenol. 2014;202(2):W140-5. doi: https://doi.org/10.2214/AJR.13.10732. PMID: 24450695.
Wnorowski AM, Guglielmo FF, Mitchell DG. How to perform and interpret cine MR enterography. J Magn Reson Imaging. 2015;42(5):1180–9. doi: https://doi.org/10.1002/jmri.24981. Epub 2015 Jul 14. PMID: 26179244.
Kohoutová D, Bártová J, Tachecí I, Rejchrt S, Repák R, Kopáčová M, Bureš J. Cryptogenic multifocal ulcerous stenosing enteritis: a review of the literature. Gastroenterol Res Pract. 2013;2013:918031. doi: https://doi.org/10.1155/2013/918031. Epub 2013 Nov 24. PMID: 24369459; PMCID: PMC3858008.
Ramos GP, Bartlett DJ, Bledsoe AC, Bruining DH, Fidler JL, Sheedy SP, Murray J. Cryptogenic multifocal ulcerous stenosing enteritis (CMUSE): a 20-year single-center clinical and radiologic experience. Abdom Radiol (NY). 2021;46(8):3798–3809. doi: https://doi.org/10.1007/s00261-021-03005-y. Epub 2021 Mar 16. PMID: 33728531.
Hwang J, Kim JS, Kim AY, Lim JS, Kim SH, Kim MJ, Kim MS, Song KD, Woo JY. Cryptogenic multifocal ulcerous stenosing enteritis: Radiologic features and clinical behavior. World J Gastroenterol. 2017;23(25):4615–4623. doi: https://doi.org/10.3748/wjg.v23.i25.4615. PMID: 28740350; PMCID: PMC5504377.
Masselli G, Picarelli A, Gualdi G. Celiac disease: MR enterography and contrast enhanced MRI. Abdom Imaging. 2010;35(4):399–406. doi: https://doi.org/10.1007/s00261-009-9531-x. Epub 2009 May 13. PMID: 19437064.
Radmard AR, Hashemi Taheri AP, Salehian Nik E, Kooraki S, Kolahdoozan S, Mirminachi B, Sotoudeh M, Ekhlasi G, Malekzadeh R, Shahbazkhani B. MR enterography in nonresponsive adult celiac disease: Correlation with endoscopic, pathologic, serologic, and genetic features. J Magn Reson Imaging. 2017;46(4):1096–1106. doi: https://doi.org/10.1002/jmri.25646. Epub 2017 Feb 9. PMID: 28182308.
Mehmood S, Zhao S, Ain Q, Van Dellen J, Beggan C. Endometriosis of the Small Bowel: A Diagnostic Enigma. Cureus. 2021;13(6):e15520. doi: https://doi.org/10.7759/cureus.15520. PMID: 34268046; PMCID: PMC8265278.
Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Réty F, Valette PJ. Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography–initial results. Radiology. 2014;273(1):117– 24. doi: https://doi.org/10.1148/radiol.14132803. Epub 2014 May 12. PMID: 24828001.
Bazot M, Kermarrec E, Bendifallah S, Daraï E. MRI of intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol. 2021;71:51–63. doi: https://doi.org/10.1016/j.bpobgyn.2020.05.013. Epub 2020 Jun 14. PMID: 32653334.
Katayama M, Masui T, Kobayashi S, Ito T, Sakahara H, Nozaki A, Kabasawa H. Evaluation of pelvic adhesions using multiphase and multislice MR imaging with kinematic display. AJR Am J Roentgenol. 2001;177(1):107– 10. doi: https://doi.org/10.2214/ajr.177.1.1770107. PMID: 11418407.
Pagacz M, Willis I, Alexis J. Massive Lipomatosis of the Small Intestine Causing Intussusception. Case Rep Gastrointest Med. 2019;2019:9701478. doi: https://doi.org/10.1155/2019/9701478. PMID: 31929919; PMCID: PMC6939428.
Jasti R, Carucci LR. Small Bowel Neoplasms: A Pictorial Review. Radiographics. 2020 Jul-Aug;40(4):1020–1038. doi: 10.1148/rg.2020200011. Epub 2020 Jun 19. PMID: 32559148.
Ingle SB, Hinge Ingle CR. Primary intestinal lymphangiectasia: Minireview. World J Clin Cases. 2014;2(10):528–33. doi: https://doi.org/10.12998/wjcc.v2.i10.528. PMID: 25325063; PMCID: PMC4198405.
Holzknecht N, Helmberger T, Beuers U, Rust C, Wiebecke B, Reiser M. Cross-sectional imaging findings in congenital intestinal lymphangiectasia. J Comput Assist Tomogr. 2002 Jul-Aug;26(4):526-8. doi: https://doi.org/10.1097/00004728-200207000-00009. PMID: 12218814.
Yalon M, Tahboub Amawi AD, Kelm ZS, Wells ML, Teo LLS, Heiken JP, Sheedy SP, Torbenson MS, Fidler JL, Venkatesh SK. Eosinophilic Disorders of the Gastrointestinal Tract and Associated Abdominal Viscera: Imaging Findings and Diagnosis. Radiographics. 2022 Jul-Aug;42(4):1081–1102. doi: https://doi.org/10.1148/rg.220004. Epub 2022 Jun 24. PMID: 35749291.
Lopes Vendrami C, Kelahan L, Escobar DJ, Goodhartz L, Hammond N, Nikolaidis P, Yang GY, Hirano I, Miller FH. “Imaging Findings of Eosinophilic Gastrointestinal Diseases in Adults”. Curr Probl Diagn Radiol. 2023 Mar-Apr;52(2):139–147. doi: 10.1067/j.cpradiol.2022.11.010. Epub 2022 Nov 22. PMID: 36517296.
Wang Q, Wang D. Abdominal cocoon: multi-detector row CT with multiplanar reformation and review of literatures. Abdom Imaging. 2010;35(1):92–4. doi: https://doi.org/10.1007/s00261-008-9489-0. Epub 2008 Dec 2. PMID: 19048332.
Singhal M, Krishna S, Lal A, Narayanasamy S, Bal A, Yadav TD, Kochhar R, Sinha SK, Khandelwal N, Sheikh AM. Encapsulating Peritoneal Sclerosis: The Abdominal Cocoon. Radiographics. 2019 Jan-Feb;39(1):62–77. doi: https://doi.org/10.1148/rg.2019180108. Epub 2018 Dec 7. PMID: 30526331.
Heye T, Stein D, Antolovic D, Dueck M, Kauczor HU, Hosch W. Evaluation of bowel peristalsis by dynamic cine MRI: detection of relevant functional disturbances–initial experience. J Magn Reson Imaging. 2012;35(4):859–67. doi: https://doi.org/10.1002/jmri.22851. Epub 2012 Jan 20. PMID: 22267053.
Wnorowski AM, Guglielmo FF, Mitchell DG. How to perform and interpret cine MR enterography. J Magn Reson Imaging. 2015;42(5):1180–9. doi: https://doi.org/10.1002/jmri.24981. Epub 2015 Jul 14. PMID: 26179244.
Addley HC, Vargas HA, Moyle PL, Crawford R, Sala E. Pelvic imaging following chemotherapy and radiation therapy for gynecologic malignancies. Radiographics. 2010;30(7):1843–56. doi: https://doi.org/10.1148/rg.307105063. PMID: 21057123; PMCID: PMC6939852.
Algin O, Turkbey B, Ozmen E, Algin E. Magnetic resonance enterography findings of chronic radiation enteritis. Cancer Imaging. 2011;11(1):189–94. doi: https://doi.org/10.1102/1470-7330.2011.0026. PMID: 22138564; PMCID: PMC3266583
Ishigami K, Averill SL, Pollard JH, McDonald JM, Sato Y. Radiologic manifestations of angioedema. Insights Imaging. 2014;5(3):365– 74. doi: 10.1007/s13244-014-0329-1. Epub 2014 May 3. PMID: 24792779; PMCID: PMC4035492.
Savino MR, Mittal PK, Miller FH. MR imaging of intestinal angioedema related to angiotensin-converting enzyme inhibitors: Report of three cases and review of literature. Clin Imaging. 2017 May-Jun;43:122–126. doi: https://doi.org/10.1016/j.clinimag.2017.03.001. Epub 2017 Mar 8. PMID: 28292712.
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Conceptualization: Chandan Kakkar, Pietro Andrea Bonaffini, Saurabh SinglaLiterature search: Chandan Kakkar, Pietro Andrea Bonaffini, Arshdeep Singh, Saurabh Singla Images and legends: Chandan Kakkar, Pietro Andrea Bonaffini, Shruti VermaManuscript writing: Chandan Kakkar, Pietro Andrea Bonaffini, Vikram NarangManuscript review: Chandan Kakkar, Ajit Sood, Ramit MahajanManuscript editing: Chandan Kakkar, Vikram Narang, Ajit Sood, Arshdeep SinghFinal approval: All authors.
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Kakkar, C., Bonaffini, P., Singh, A. et al. MR enterography in Crohns disease and beyond: a pictorial review. Abdom Radiol 51, 1129–1142 (2026). https://doi.org/10.1007/s00261-025-04824-z
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DOI: https://doi.org/10.1007/s00261-025-04824-z
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