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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.


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Example of DWI in active inflammation: a axial T1 fat-saturated post-contrast image shows thickened enhancing ileum with typical stratified enhancement pattern (arrow); b corresponding DWI (b = 800) and c ADC map confirm restricted diffusion with persistent high signal (arrow) on the DWI and low signal (arrow) on the ADC map (ROI = 1,200)
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Fig11: Example of DWI in active inflammation: a axial T1 fat-saturated post-contrast image shows thickened enhancing ileum with typical stratified enhancement pattern (arrow); b corresponding DWI (b = 800) and c ADC map confirm restricted diffusion with persistent high signal (arrow) on the DWI and low signal (arrow) on the ADC map (ROI = 1,200)

Mentions: In the last 5 years, there have been several studies [25–27] that have suggested that DWI may have an adjunctive role in the assessment of disease activity in affected bowel. Either visual assessment of DWI or quantitative assessment of the ADC value can be made. Restricted diffusion in affected bowel segments is more likely in active inflammation (Fig. 11a-c) compared to fibrostenotic disease [25–27].Fig. 11


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 DWI in active inflammation: a axial T1 fat-saturated post-contrast image shows thickened enhancing ileum with typical stratified enhancement pattern (arrow); b corresponding DWI (b = 800) and c ADC map confirm restricted diffusion with persistent high signal (arrow) on the DWI and low signal (arrow) on the ADC map (ROI = 1,200)
© Copyright Policy
Related In: Results  -  Collection

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

Fig11: Example of DWI in active inflammation: a axial T1 fat-saturated post-contrast image shows thickened enhancing ileum with typical stratified enhancement pattern (arrow); b corresponding DWI (b = 800) and c ADC map confirm restricted diffusion with persistent high signal (arrow) on the DWI and low signal (arrow) on the ADC map (ROI = 1,200)
Mentions: In the last 5 years, there have been several studies [25–27] that have suggested that DWI may have an adjunctive role in the assessment of disease activity in affected bowel. Either visual assessment of DWI or quantitative assessment of the ADC value can be made. Restricted diffusion in affected bowel segments is more likely in active inflammation (Fig. 11a-c) compared to fibrostenotic disease [25–27].Fig. 11

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