ISRA May 2022

Diagnostic Significance of Mesenteric Lymph Node Involvement in Proximal Small Bowel Crohn’s Disease

Vera Sorin 1,2 Giovanni Maconi 3 Uri Kopylov 2,4 Oranit Barzilay 2,4 Francesca Ferretti 3 Silvia Innamorati 5 Massimo Tonolini 5 Shomron Ben-Horin 2,4 Rami Eliakim 2,4 Michal Marianne Amitai 1,2
1Department of Radiology, Chaim Sheba Medical Center, Israel
2Sackler School of Medicine, Tel-Aviv University, Israel
3Department of Gastroenterology, ASST Fatebenefratelli Sacco, Sacco University Hospital, Italy
4Department of Gastroenterology, Chaim Sheba Medica Center, Israel
5Department of Radiology, ASST Fatebenefratelli-Sacco, L. Sacco University Hospital, Italy

Purpose: To evaluate whether proximal mesenteric lymph nodes and their magnetic resonance enterography (MRE) features in Crohn’s disease (CD) are associated with proximal bowel disease as detected by video capsule endoscopy (VCE).

Methods: This retrospective study was performed in two tertiary medical centers, and included 64 patients with CD who underwent MRE as well as VCE within one year. Data were collected for examinations performed between August 2013 and February 2021. MRE images were independently reviewed by radiologists who were blinded to the clinical data. Associations between MRE lymph nodes features and disease activity according to VCE Lewis scores of proximal small bowel were examined.

Results: VCE detected proximal disease in 24/64 patients (37.5%). Presence of regional lymph nodes at left upper quadrant was significantly associated with jejunal disease (P<0.001). Of the 20 patients who had proximal mesenteric lymph nodes at MRE, 15 (75%) had jejunal disease at VCE (sensitivity 62.5%, specificity 87.5%, negative and positive predictive values 79.5% and 75% respectively). The number of regional lymph nodes was positively correlated with jejunal disease (mean 2.63±2.90 vs. 0.78±2.60, P=0.01). Other MRE features of lymph nodes were not significantly predictive of jejunal CD.

Conclusions: In patients with CD, regional lymph nodes assessment at MRE can be valuable to suggest proximal small bowel disease. Absence of regional lymph nodes could spare endoscopic investigation of the proximal bowel.