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Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


Related in: MedlinePlus

Example of comb sign in active inflammation: coronal True FISP image shows multiple linear low signal structures extending to the bowel wall in keeping with engorged vasa recta (arrows) supplying the thickened terminal ileum (asterisk). Note the fibrofatty proliferation within the adjacent mesentery, separating the inflamed terminal ileum from adjacent loops of bowel, with small mesenteric nodes also present
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Fig10: Example of comb sign in active inflammation: coronal True FISP image shows multiple linear low signal structures extending to the bowel wall in keeping with engorged vasa recta (arrows) supplying the thickened terminal ileum (asterisk). Note the fibrofatty proliferation within the adjacent mesentery, separating the inflamed terminal ileum from adjacent loops of bowel, with small mesenteric nodes also present

Mentions: In active inflammation, the vascular arcades (vasa recta) supplying the involved bowel segment become engorged. These are straight vessels that extend perpendicular to the bowel wall within the mesentery and resemble the teeth of a comb. They appear as low signal linear structures on True FISP images (Fig. 10) with enhancement post-contrast. Prominent reactive enhancing mesenteric nodes (up to 8 mm in short axis diameter) will also be seen in active inflammation (Figs. 5, 10). If larger volume adenopathy is seen, the development of lymphoma needs to be excluded.Fig. 10


Small bowel MR enterography: problem solving in Crohn's disease.

Griffin N, Grant LA, Anderson S, Irving P, Sanderson J - Insights Imaging (2012)

Example of comb sign in active inflammation: coronal True FISP image shows multiple linear low signal structures extending to the bowel wall in keeping with engorged vasa recta (arrows) supplying the thickened terminal ileum (asterisk). Note the fibrofatty proliferation within the adjacent mesentery, separating the inflamed terminal ileum from adjacent loops of bowel, with small mesenteric nodes also present
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369125&req=5

Fig10: Example of comb sign in active inflammation: coronal True FISP image shows multiple linear low signal structures extending to the bowel wall in keeping with engorged vasa recta (arrows) supplying the thickened terminal ileum (asterisk). Note the fibrofatty proliferation within the adjacent mesentery, separating the inflamed terminal ileum from adjacent loops of bowel, with small mesenteric nodes also present
Mentions: In active inflammation, the vascular arcades (vasa recta) supplying the involved bowel segment become engorged. These are straight vessels that extend perpendicular to the bowel wall within the mesentery and resemble the teeth of a comb. They appear as low signal linear structures on True FISP images (Fig. 10) with enhancement post-contrast. Prominent reactive enhancing mesenteric nodes (up to 8 mm in short axis diameter) will also be seen in active inflammation (Figs. 5, 10). If larger volume adenopathy is seen, the development of lymphoma needs to be excluded.Fig. 10

Bottom Line: Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations.MRE can help address this question.The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Guy's & St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK, nyreegriffin100@gmail.com.

ABSTRACT
Magnetic resonance enterography (MRE) is fast becoming the first-line radiological investigation to evaluate the small bowel in patients with Crohn's disease. It can demonstrate both mural and extramural complications. The lack of ionizing radiation, together with high-contrast resolution, multiplanar capability and cine-imaging make it an attractive imaging modality in such patients who need prolonged follow-up. A key question in the management of such patients is the assessment of disease activity. Clinical indices, endoscopic and histological findings have traditionally been used as surrogate markers but all have limitations. MRE can help address this question. The purpose of this pictorial review is to (1) detail the MRE protocol used at our institution; (2) describe the rationale for the MR sequences used and their limitations; (3) compare MRE with other small bowel imaging techniques; (4) discuss how MRE can help distinguish between inflammatory, stricturing and penetrating disease, and thus facilitate management of this difficult condition. Main Messages • MR enterography (MRE) is the preferred imaging investigation to assess Crohn's disease. T2-weighted, post-contrast and diffusion-weighted imaging (DWI) can be used. • MRE offers no radiation exposure, high-contrast resolution, multiplanar ability and cine imaging. • MRE can help define disease activity, a key question in the management of Crohn's disease. • MRE can help distinguish between inflammatory, stricturing and penetrating disease. • MRE can demonstrate both mural and extramural complications.

No MeSH data available.


Related in: MedlinePlus