Can an MRI without contrast dismiss Crohn's??

[Ebru]

I got a MRI without contrast and there was no anomaly despite the fact that I have pretty bothersome symptoms like diahrea followed by constipation which lasts approx. 4 days, weight loss (6kg/over 13lbs) and perinal fistula. My life is restricted by stomach pain. The MRI was ordered by a gynecologist and she also said we focus mostly on the utuerus and ovaries. So is it possible that it was dismissed, was it because there was no contrast? I'm awaiting blood results for amenia (doc asked if there was blood in my stool, I said maybe I think but I have no idea what such a thing is supposed to look like) and my stool will be checked as well. If that shows nothing (which I doubt for amenia since I have tinnitus, headache and energy loss) Ill be refered to an internist. Should I mention the perianal fistula this week? No mention of possible Crohn's from my GP though.

 

[Ebru]

Anyone an idea?

 

[emmaaaargh]

If the MRI was focusing on the uterus and ovaries, I would think (although I'm not a radiologist!) that it's definitely possible that the small bowel would be overlooked, especially with a lack of contrast. Asking for a small-bowel MRI with contrast might be a good idea for you, because without contrast the intestines can't be visualised very well, especially when the focus is on other organs!

Definitely mention the perianal fistula: although it can happen, it's not as common for them to just happen on their own out of nowhere, and it might add another piece to help your doctors put the puzzle together.

Hope you get some answers soon

 

[Nadia96]

I got a MRI without contrast and there was no anomaly despite the fact that I have pretty bothersome symptoms like diahrea followed by constipation which lasts approx. 4 days, weight loss (6kg/over 13lbs) and perinal fistula. My life is restricted by stomach pain. The MRI was ordered by a gynecologist and she also said we focus mostly on the utuerus and ovaries. So is it possible that it was dismissed, was it because there was no contrast? I'm awaiting blood results for amenia (doc asked if there was blood in my stool, I said maybe I think but I have no idea what such a thing is supposed to look like) and my stool will be checked as well. If that shows nothing (which I doubt for amenia since I have tinnitus, headache and energy loss) Ill be refered to an internist. Should I mention the perianal fistula this week? No mention of possible Crohn's from my GP though.

I’ve got Crohn’s disease and and have had it for 13 years now. Ihave had multiple mri scans and ct scans and usually I have them with contrast as it does give a better picture of your large and small bowel. However, some mri scans I have had done were done without contrast as they focused on my pelvis and my rectum and even without contrast, inflammation would have been detected.

The symptoms of Crohn's disease is not to be mistaken with Ulcerative Colitis. Colitis is mostly the large bowel that is inflamed and Crohn’s the whole GIT system. Continuous diarrhoea with blood, weight loss, loss of appetite and feeling faint are the most common symptoms.

It is unlikely that you have got Crohn’s as constipation will not happen and also the doctors do know from the beginning but they won’t say until they have test results back and do more tests. And the fact that it lasts for 4 days not months, makes it even more unlikely to be Crohn’s. Usually blood tests does tell as if the Platelets are really high, then there is clearly something wrong. Also, just because there is no contrast doesn’t mean that there is no inflammation. Inflatmation can still be found without contrast, it just gives it a better picture. For the bloody stools, it is fairly obvious. You can usually tell from the colour change if there is some bleeding or not. For the doctors to think that it’s a bowel problem, they would have sent you straight for a colonoscopy and not an MRI as they can usually get straight answers from a colonoscopy, but the fact that they haven’t then it’s probably a different problem. But then again I’m not a doctor or a radiologist, so I’m just telling from experience.

 

[eleanor_rigby]

I’ve got Crohn’s disease and and have had it for 13 years now. Ihave had multiple mri scans and ct scans and usually I have them with contrast as it does give a better picture of your large and small bowel. However, some mri scans I have had done were done without contrast as they focused on my pelvis and my rectum and even without contrast, inflammation would have been detected.

The symptoms of Crohn's disease is not to be mistaken with Ulcerative Colitis. Colitis is mostly the large bowel that is inflamed and Crohn’s the whole GIT system. Continuous diarrhoea with blood, weight loss, loss of appetite and feeling faint are the most common symptoms.

It is unlikely that you have got Crohn’s as constipation will not happen and also the doctors do know from the beginning but they won’t say until they have test results back and do more tests. And the fact that it lasts for 4 days not months, makes it even more unlikely to be Crohn’s. Usually blood tests does tell as if the Platelets are really high, then there is clearly something wrong. Also, just because there is no contrast doesn’t mean that there is no inflammation. Inflatmation can still be found without contrast, it just gives it a better picture. For the bloody stools, it is fairly obvious. You can usually tell from the colour change if there is some bleeding or not. For the doctors to think that it’s a bowel problem, they would have sent you straight for a colonoscopy and not an MRI as they can usually get straight answers from a colonoscopy, but the fact that they haven’t then it’s probably a different problem. But then again I’m not a doctor or a radiologist, so I’m just telling from experience.

Just to add a different perspective - Crohn’s absolutely can cause constipation, especially if you had Crohn’s in your small bowel. The small bowel only has a small diameter and if it becomes inflamed it can prevent the passage of food. There are literally dozens and dozens of posts on this forum about people with Crohn’s disease who have constipation. I think there is a risk people assume the standard Crohn’s disease symptoms apply to everyone and it’s just not true. Probably the most common symptom of Crohn’s is diarrhoea and yet it is something I never get, even after surgery 7 years ago. Nor do I experience bleeding. This can be fairly common for people who’s Crohn’s only affects the TI - a small section of the small bowel. It’s extremely rare (I’m not even sure I’ve ever read of anyone on here) for Crohn’s to affect the entire GI tract. Yes it’s possible Crohn’s can strike anywhere in the GI tract but it usually just appears in one or two places and stays there. Also you can have Crohn’s in just the large bowel, called Crohn’s colitis and this is different from ulcerative colitis although they can be hard to distinguish in the beginning. The difference is UC only affects the first layer of the bowel, whereas Crohn’s colitis is transmural.

There are also a lot of users on here who often have normal blood results and normal scans. I had a normal CT scan and normal MRI scan, both WITH contrast but two colonoscopies both revealed aphthous ulcers and inflammation from active Crohn’s. Sometimes tests that show disease for one person doesn’t pick it up in someone else and you just have to keep looking for answers until you find them. We are all different and this disease affects everyone differently and that includes diagnosis and treatment.

Furthermore, doctors don’t always get it right the first time - Crohn’s is a notoriously difficult disease for them to pick up and it is a rare disease too. Lots of users on here wait years who be properly referred and diagnosed. Many only get diagnosed after being hospitalised (including myself which was after 5 years of going back and forth to the doctors). Therefore you must tell them as much information as possible to spell it out to them.

 

[Maya142]

It is unlikely that you have got Crohn’s as constipation will not happen and also the doctors do know from the beginning but they won’t say until they have test results back and do more tests. And the fact that it lasts for 4 days not months, makes it even more unlikely to be Crohn’s. Usually blood tests does tell as if the Platelets are really high, then there is clearly something wrong. Also, just because there is no contrast doesn’t mean that there is no inflammation. Inflatmation can still be found without contrast, it just gives it a better picture.

Crohn's can absolutely cause constipation. Small bowel disease often does. And even proctitis can sometimes cause constipation. Not everyone has the typical bloody diarrhea before being diagnosed. My daughter just had abdominal pain and weight loss, as well as occasional constipation that was getting worse. We were sure we were ruling OUT Crohn's, because I had read the "normal" symptoms and she didn't have diarrhea and wasn't bleeding.

Well, what I have learned since then is that there really is no "normal" - everyone is different. Some people's labs are completely normal and others show inflammation. High platelets suggest inflammation and of course a high CRP and ESR suggest inflammation. But not everyone has high inflammatory markers - I recently read a study that said some 40% of Crohn's patients did NOT have high ESR or CRP.

Fecal Calprotectin is a much more accurate marker, since it is specific to the gut.

I would definitely ask about an MRE which is better imaging for the small bowel. For that you will drink contrast (barium usually) and they give you IV contrast.

Have you seen a GI yet and had a colonoscopy? Because generally that would be the first step. A perianal fistula could certainly be a sign of Crohn's and honestly, with your stomach pain and weight loss along with fistula, I think you need to be seen by a GI ASAP.

 

[Ebru]

If the MRI was focusing on the uterus and ovaries, I would think (although I'm not a radiologist!) that it's definitely possible that the small bowel would be overlooked, especially with a lack of contrast. Asking for a small-bowel MRI with contrast might be a good idea for you, because without contrast the intestines can't be visualised very well, especially when the focus is on other organs!

Definitely mention the perianal fistula: although it can happen, it's not as common for them to just happen on their own out of nowhere, and it might add another piece to help your doctors put the puzzle together.

Hope you get some answers soon

Hello. That was also what I thought but the GP simply said: "They did the MRI, end of story." She only offered a referal to an internist. She is not aware of the draining fistula but I'm going to call for that tomorrow. I hope the fistula will lead me to a hospital where they diagnose me. As soon as I'm there I'll simply ask another MRI. This pain is not normal. Thank you for your answer. <3

 

[Lynda Lynda]

I had several tests before my recent diagnosis...stool, blood, CT scan, colonoscopy /endoscopy.

I am glad my Gastroenterologist was so thorough.

I'm not happy with the diagnosis of Crohn's but now I know why I have been so sick the last few months !

 

[lukesjr]

I had every test you can think of, all came back fine. MRI with contrast, showed no evidence of crohns. Yet I still had problems. So my GI did a pill cam and saw inflammation/crohns.