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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 mural thickening in active Crohn’s disease: a axial True FISP image shows mural thickening in the distal ileum (arrow); b coronal True FISP in a different patient (15 years old) shows extensive jejunal small bowel wall thickening (arrows); this distribution of disease is less common than distal/terminal ileum. Note the fibrofatty proliferation in the adjacent mesentery
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Fig4: Example of mural thickening in active Crohn’s disease: a axial True FISP image shows mural thickening in the distal ileum (arrow); b coronal True FISP in a different patient (15 years old) shows extensive jejunal small bowel wall thickening (arrows); this distribution of disease is less common than distal/terminal ileum. Note the fibrofatty proliferation in the adjacent mesentery

Mentions: The hallmark of CD on cross-sectional imaging is bowel wall thickening (Fig. 4a, b) (between 4 to 12 mm), usually in association with luminal stenosis. Normal bowel wall thickness, when adequately distended, should not exceed 3 mm. Mural thickening can be appreciated on all sequences. The commonest site of involvement is the terminal ileum (sometimes with contiguous disease in the caecum). Discontinuous skip lesions may be seen more proximally in the small bowel or within the colon. If there is suboptimal distension (as is sometimes the case, especially with jejunal loops), disease may be overestimated or underestimated. Early disease, characterised by mucosal changes only, may also not be appreciated on MRE. The evaluation of all sequences may help clarify the extent of bowel involvement, as fluid distension in the small bowel will vary over time. Strictures can also be distinguished from peristalsis on the cine sequence. Involvement of the bowel wall may be symmetrical or asymmetrical, where greater involvement of the mesenteric border leads to pseudo-sacculation (Fig. 5). With repeated episodes of acute inflammation, mesenteric fibrofatty proliferation (‘creeping fat’/‘fat wrapping’) tends to develop along the mesenteric border of the involved segment of bowel (Fig. 5); this is a helpful additional feature on MRE denoting the site of disease.Fig. 4


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 mural thickening in active Crohn’s disease: a axial True FISP image shows mural thickening in the distal ileum (arrow); b coronal True FISP in a different patient (15 years old) shows extensive jejunal small bowel wall thickening (arrows); this distribution of disease is less common than distal/terminal ileum. Note the fibrofatty proliferation in the adjacent mesentery
© Copyright Policy
Related In: Results  -  Collection

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Fig4: Example of mural thickening in active Crohn’s disease: a axial True FISP image shows mural thickening in the distal ileum (arrow); b coronal True FISP in a different patient (15 years old) shows extensive jejunal small bowel wall thickening (arrows); this distribution of disease is less common than distal/terminal ileum. Note the fibrofatty proliferation in the adjacent mesentery
Mentions: The hallmark of CD on cross-sectional imaging is bowel wall thickening (Fig. 4a, b) (between 4 to 12 mm), usually in association with luminal stenosis. Normal bowel wall thickness, when adequately distended, should not exceed 3 mm. Mural thickening can be appreciated on all sequences. The commonest site of involvement is the terminal ileum (sometimes with contiguous disease in the caecum). Discontinuous skip lesions may be seen more proximally in the small bowel or within the colon. If there is suboptimal distension (as is sometimes the case, especially with jejunal loops), disease may be overestimated or underestimated. Early disease, characterised by mucosal changes only, may also not be appreciated on MRE. The evaluation of all sequences may help clarify the extent of bowel involvement, as fluid distension in the small bowel will vary over time. Strictures can also be distinguished from peristalsis on the cine sequence. Involvement of the bowel wall may be symmetrical or asymmetrical, where greater involvement of the mesenteric border leads to pseudo-sacculation (Fig. 5). With repeated episodes of acute inflammation, mesenteric fibrofatty proliferation (‘creeping fat’/‘fat wrapping’) tends to develop along the mesenteric border of the involved segment of bowel (Fig. 5); this is a helpful additional feature on MRE denoting the site of disease.Fig. 4

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