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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

Coronal T1 fat-saturated post-contrast image: normal bowel wall shows mild homogeneous enhancement
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Fig2: Coronal T1 fat-saturated post-contrast image: normal bowel wall shows mild homogeneous enhancement

Mentions: The post-contrast sequence involves a three-dimensional (3D) T1-weighted fat-saturated spoiled gradient echo sequence (Fig. 2) performed 70 s following hand injection of 0.2 ml/kg (0.1 mmol/kg) intravenous Gadoteric acid (Dotarem, Guerbet). Gadolinium is not given in patients with chronic renal impairment, due to the potential long-term risk of nephrogenic systemic fibrosis. A pre-contrast sequence is routinely performed. Some institutions use a dynamic post-contrast coronal acquisition; for example, a volume interpolated breath-hold examination (VIBE) can be performed in the arterial (30 s—optional) and portal venous (60-70 s) phases using bolus triggering once contrast reaches the descending aorta. With a 3D sequence, a radiofrequency pulse excites a thick volume of tissue rather than a thin 2D section, with increased spatial resolution. The 3D sequence is, however, sensitive to motion artefact. Bowel peristalsis is reduced by the prior intravenous administration of a spasmolytic. This usually consists of 20 mg intravenous hyoscine-N-butylbromide (buscopan). Buscopan is routinely given unless contra-indicated (e.g. history of cardiac arrhythmia, narrow angle glaucoma or prostatism). In instances when this cannot be administered, 1 mg intravenous glucagon is given as an alternative unless patients have a known hypersensitivity to glucagon or a history of phaeochromocytoma.. The purpose of this sequence is to assess bowel wall and mesenteric nodal enhancement and to evaluate for the presence of any rim-enhancing fluid collections.Fig. 2


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

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

Coronal T1 fat-saturated post-contrast image: normal bowel wall shows mild homogeneous enhancement
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: Coronal T1 fat-saturated post-contrast image: normal bowel wall shows mild homogeneous enhancement
Mentions: The post-contrast sequence involves a three-dimensional (3D) T1-weighted fat-saturated spoiled gradient echo sequence (Fig. 2) performed 70 s following hand injection of 0.2 ml/kg (0.1 mmol/kg) intravenous Gadoteric acid (Dotarem, Guerbet). Gadolinium is not given in patients with chronic renal impairment, due to the potential long-term risk of nephrogenic systemic fibrosis. A pre-contrast sequence is routinely performed. Some institutions use a dynamic post-contrast coronal acquisition; for example, a volume interpolated breath-hold examination (VIBE) can be performed in the arterial (30 s—optional) and portal venous (60-70 s) phases using bolus triggering once contrast reaches the descending aorta. With a 3D sequence, a radiofrequency pulse excites a thick volume of tissue rather than a thin 2D section, with increased spatial resolution. The 3D sequence is, however, sensitive to motion artefact. Bowel peristalsis is reduced by the prior intravenous administration of a spasmolytic. This usually consists of 20 mg intravenous hyoscine-N-butylbromide (buscopan). Buscopan is routinely given unless contra-indicated (e.g. history of cardiac arrhythmia, narrow angle glaucoma or prostatism). In instances when this cannot be administered, 1 mg intravenous glucagon is given as an alternative unless patients have a known hypersensitivity to glucagon or a history of phaeochromocytoma.. The purpose of this sequence is to assess bowel wall and mesenteric nodal enhancement and to evaluate for the presence of any rim-enhancing fluid collections.Fig. 2

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