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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

Complications of penetrating disease: a coronal True FISP image showing an enteroenteric fistula (arrows) between an inflamed segment of mid ileum (white asterisk) and non-inflamed terminal ileum (black asterisk); b Axial True FISP image in a different patient showing an enterocutaneous fistula (arrows) between a loop of inflamed thickened small bowel (asterisk) and skin; c axial True FISP image in a different patient showing the ‘star’ sign between adjacent loops of bowel, highly suggestive of enteroenteric fistulae (arrows); d coronal T1 fat saturated post contrast image in a different patient again showing multiple converging enhancing loops of small bowel suggestive of enteroenteric fistulae (arrows)
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Fig12: Complications of penetrating disease: a coronal True FISP image showing an enteroenteric fistula (arrows) between an inflamed segment of mid ileum (white asterisk) and non-inflamed terminal ileum (black asterisk); b Axial True FISP image in a different patient showing an enterocutaneous fistula (arrows) between a loop of inflamed thickened small bowel (asterisk) and skin; c axial True FISP image in a different patient showing the ‘star’ sign between adjacent loops of bowel, highly suggestive of enteroenteric fistulae (arrows); d coronal T1 fat saturated post contrast image in a different patient again showing multiple converging enhancing loops of small bowel suggestive of enteroenteric fistulae (arrows)

Mentions: Blind ending sinus tracts and fistulae may develop in active CD due to transmural bowel inflammation and penetrating ulceration. Enteroenteric (Fig. 12a), enterocolic, enterovesical and enterocutaneous (Fig. 12b) fistulae may arise. These are usually well demonstrated on the True FISP and HASTE sequences due to high signal fluid content within the tracts, but will also be seen as rim-enhancing low-signal tracts on the post-contrast images. The ‘star’ sign (Fig. 12c, d) is where multiple converging loops of inflamed bowel are seen and is suggestive of enteroenteric fistulae. It has been shown that MRE has an overall sensitivity for sinus tracts and fistulae of >75% and specificity of 100%, when compared with MR enteroclysis and conventional enteroclysis as the reference standards [6].Fig. 12


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

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

Complications of penetrating disease: a coronal True FISP image showing an enteroenteric fistula (arrows) between an inflamed segment of mid ileum (white asterisk) and non-inflamed terminal ileum (black asterisk); b Axial True FISP image in a different patient showing an enterocutaneous fistula (arrows) between a loop of inflamed thickened small bowel (asterisk) and skin; c axial True FISP image in a different patient showing the ‘star’ sign between adjacent loops of bowel, highly suggestive of enteroenteric fistulae (arrows); d coronal T1 fat saturated post contrast image in a different patient again showing multiple converging enhancing loops of small bowel suggestive of enteroenteric fistulae (arrows)
© Copyright Policy
Related In: Results  -  Collection

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

Fig12: Complications of penetrating disease: a coronal True FISP image showing an enteroenteric fistula (arrows) between an inflamed segment of mid ileum (white asterisk) and non-inflamed terminal ileum (black asterisk); b Axial True FISP image in a different patient showing an enterocutaneous fistula (arrows) between a loop of inflamed thickened small bowel (asterisk) and skin; c axial True FISP image in a different patient showing the ‘star’ sign between adjacent loops of bowel, highly suggestive of enteroenteric fistulae (arrows); d coronal T1 fat saturated post contrast image in a different patient again showing multiple converging enhancing loops of small bowel suggestive of enteroenteric fistulae (arrows)
Mentions: Blind ending sinus tracts and fistulae may develop in active CD due to transmural bowel inflammation and penetrating ulceration. Enteroenteric (Fig. 12a), enterocolic, enterovesical and enterocutaneous (Fig. 12b) fistulae may arise. These are usually well demonstrated on the True FISP and HASTE sequences due to high signal fluid content within the tracts, but will also be seen as rim-enhancing low-signal tracts on the post-contrast images. The ‘star’ sign (Fig. 12c, d) is where multiple converging loops of inflamed bowel are seen and is suggestive of enteroenteric fistulae. It has been shown that MRE has an overall sensitivity for sinus tracts and fistulae of >75% and specificity of 100%, when compared with MR enteroclysis and conventional enteroclysis as the reference standards [6].Fig. 12

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