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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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Coronal fat-saturated HASTE image: normal bowel. Intraluminal flow voids (arrow) are seen, as this sequence is sensitive to fluid motion
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Fig3: Coronal fat-saturated HASTE image: normal bowel. Intraluminal flow voids (arrow) are seen, as this sequence is sensitive to fluid motion

Mentions: The HASTE (half-Fourier acquired single-shot fast spin echo) sequence is a fast sequence consisting of heavily T2-weighted images. It is a pulse sequence with a very long echo train, where each echo is individually phase encoded. The partial Fourier technique assumes symmetry of raw data in K-space, to reduce data acquisition time. However, this results in a reduced signal-to-noise ratio. It is good at depicting fluid, but other tissues with short T2 values are associated with blurring artefact. It is sensitive to intraluminal flow voids (Fig. 3) and is thus performed after the intravenous administration of a spasmolytic. The HASTE sequence is used to assess for mural oedema. The optional use of fat saturation on one of the T2-weighted sequences (either the True FISP or HASTE sequence) allows differentiation between submucosal fat and oedema which both appear bright on T2-weighted images. Fat saturation also increases the conspicuousness of oedematous bowel loops.Fig. 3


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

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

Coronal fat-saturated HASTE image: normal bowel. Intraluminal flow voids (arrow) are seen, as this sequence is sensitive to fluid motion
© Copyright Policy
Related In: Results  -  Collection

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

Fig3: Coronal fat-saturated HASTE image: normal bowel. Intraluminal flow voids (arrow) are seen, as this sequence is sensitive to fluid motion
Mentions: The HASTE (half-Fourier acquired single-shot fast spin echo) sequence is a fast sequence consisting of heavily T2-weighted images. It is a pulse sequence with a very long echo train, where each echo is individually phase encoded. The partial Fourier technique assumes symmetry of raw data in K-space, to reduce data acquisition time. However, this results in a reduced signal-to-noise ratio. It is good at depicting fluid, but other tissues with short T2 values are associated with blurring artefact. It is sensitive to intraluminal flow voids (Fig. 3) and is thus performed after the intravenous administration of a spasmolytic. The HASTE sequence is used to assess for mural oedema. The optional use of fat saturation on one of the T2-weighted sequences (either the True FISP or HASTE sequence) allows differentiation between submucosal fat and oedema which both appear bright on T2-weighted images. Fat saturation also increases the conspicuousness of oedematous bowel loops.Fig. 3

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