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  • Q&A with Australian Health Practitioners

    Why do I need to have an MRI for my IBD?

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    Crohn's Disease & Ulcerative Colitis Digestive Health
    I get a methotrexate injection weekly for my IBD and my LFT blood tests keeps raising. I am also on prednisolone (trying to taper off since october)and on other meds my gi believes that the mTx IS NOT effecting the liver and something else might be going on and now I have to have an MRI chem test? and said it is common for people with IBD to have some issues with liver but he didin't explain why I need this test. what will he be looking for? also I have heard that milk thistle is good for the liver and thinking of taking it to help what are you thoughts on this also.
    • 1 answer
    • Dr Kannan Venugopal
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  • Dr Kannan Venugopal

    Gastroenterologist

    I am an adult gastroenterologist working in Perth, WA. I have trained in Perth and Edinburgh, UK. After completing my speciality gastroenterology training, i have … View Profile

    Methotrexate, while being an effective drug in the mangement of Crohn's disease, can be potentially liver toxic. The toxicity is determined, typically, by the duration and dose of this therapy. If you have had more than 1.5g of MTX, you are more at risk of MTX induced liver toxicity, though this is more a guide than a strict rule).
    MRI in inflammatory bowel diseases are done in at least 3 situations ( though not limited to)
    1. To look for evidence of primary sclerosing cholangitis.  This can be seen in upto 5% of patients with ulcerative colitis and in upto 3% of patients with Crohns disease . This is a condition where the intra and extra hepatic ( inside and outside the liver) bile ducts  are inflamed and become strictured secondary to fibrotic scarring. Development of PSC, as it is called, does impart a worser prognosis to most patients with IBD as there is a risk of developing both cholangiocarcinoma ( cancer arising form bile ducts) and bowel cancer in patients with PSC.
    2. To look for evidence of small bowel crohn's disease and to define its extent. This is done usually, when there is inflammation seen in the terminal ileum at endoscopy, but assessment of the same is not possible at time of endoscopy, either due to inflammation being noted past the extent of examination or due to stricturing of the small bowel which prevents further examination. MR small bowel enteroclysis ( as it is called) is a minimally invasive method to assess small bowel inflammation in Crohn's disease.
    3. To define and delineate perianal crohn's disease- particularly to look for fistulae, perineal collections ( abscesses) and to determine progress of perianal disease when a patient is on treatment ( for eg, to assess fistula healing)

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