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MRI results help

I was diagnosed with crohn's disease many years ago and have had a recent MRI which I don't quite understand.

The findings state:  "Status post partial ileocolectomy.  Narrowing, wall thickening, and mucosal hyper enhancement involving about 4.3 cm of distal ileum, consistent with active crohns disease, with possible stricture.  Mucosal hyper enhancement extends distally to anastomosis and proximal to involve 5.5 more cm to distal ileum.  There is 1.5 cm focus of persistent narrowing and thickening with mucosal hyper enhancement in mid to distal ileum suggestive of active disease with stricture and mild proximal ileal dilatation....Impression:  Active crohn's disease involving segments of ileum and possible focal stricture in mid distal ileum.  No fistula and no abscess.

I am confused because I thought MRI's would tell you with certainty what was going on in the small bowel.  Why does it say "possible" stricture and is there a test that would tell for sure if there is a stricture?  Also what kind of stricture--inflammatory or fibrotic?  I am currently on 5ASA medication and do not want to start stronger biologics, especially if I don't know for sure whether I have a stricture and also the kind of stricture and how bad it may be. From what I've read no medication will resolve a fibrotic (scar tissue) stricture and biologics can cause very rapid healing in an inflammatory stricture which causes scar tissue formation causing a stricture to worsen and may lead to a blockage and emergency surgery.  If I have to have a stricture pasty I would prefer to have it done as elective surgery and not as an emergency.  I am having an appt. with my GI soon to discuss treatment and I know he will be pushing biologics and I want to be prepared with as much information as possible because I view biologics as a last resort option.  Also do you think adding Entocort to Pentasa may be something to try and then reevaluate to see if the "possible" stricture is still there a few months from now?  

This was a long post with many questions and I thank you ahead of time for your responses!
Nicole
1 Responses
1711789 tn?1361311607
MEDICAL PROFESSIONAL
Hey Nicole!

An MRI can just assume since the lesion is not directly observed and hence the term ‘possible’ which could actually be a stricture or a spasmodic segment. Inflammation per say does not causes strictures in the early stages; the cause of stricture is scarring and fibrosis in the later stages. Medications are unlikely to be helpful with already formed strictures. I would suggest consulting a gastroenterologist for suggestion of an appropriate management plan.
Hope this helps.

Take care!
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