MR Enterography

BROOKLYN 3MRI USER GROUPCate HOLLINSHEAD

Sat 31st Aug 2013Session 4 / Talk 115:25 15:45ABSTRACTMagnetic Resonance (MR) Enterography has become a common examination requested at out MR practice, especially for patients with Crohns Disease. High resolution MRI has many advantages for these patients, who may require further follow-up examinations over their lifetime. This talk will discuss the advantages of MR imaging of the small bowel using MR Enterography.It will covera brief overview of anatomy of the bowelclinical indications and the diseases most commonly involved with small bowel imagingoral and intravenous contrast agents usedthe importance of patient preparationpulse sequences used by our practicelimitations of imagingcase studiesMR Enterography

Cate HollinsheadMRECommon examination, especially for patients with Crohns DiseaseEvaluation of intra- and extra-luminal structuresAid in diagnosis, assessment and exclusion of small bowel disease

Crohns DiseaseIdiopathic chronic inflammatory disease of the GI tractMost commonly affects the terminal ileum and ileo-caecal regionOnset usually in early adulthoodAnother peak in 50-70sSymptoms of Crohns DiseaseVague abdominal painWeight lossDiarrhoeaSinuses, ano-rectal fistula, abscessesObstruction

Characterization of CrohnsUlceration of the bowelErosionInflammationSkip lesions

Advantages & DisadvantagesHigh resolutionHigh tissue-contrastMulti-planarAbsence of ionizing radiationCan be combined with MR imaging of the pelvisRelies on adequate bowel preparation to provide luminal distensionCost

Patient PreparationNBM for 4 hoursDrink 3 bottles of VoLumen in the hour prior to their examinationIV access

MRE TechniqueCoronal T2 & T2 F/S SSFSEAxial T2 & T2 F/S SSFSEAxial DWI B500Coronal FIESTA F/SCoronal FIESTA DynamicCoronal LAVA-Flex Pre-ContrastCoronal LAVA-Flex Post-Contrast DynamicAxial LAVA-Flex Delayed

Coronal FIESTA F/S

Coronal LAVA-Flex Pre-Contrast

Coronal LAVA-Flex Post-Contrast

Axial LAVA-Flex Delayed Post-ContrastCase Study #144 year old femaleLongstanding Crohns diseaseAbnormal bowel habitIleitis on colonoscopy

Case Study # 1

Case Study # 1Post Contrast ImagesCase study # 244 year old femaleLong term Crohns diseaseTotal colectomy and ileostomy done 10 years agoCrampy abdominal pain

Case Study # 2

Case Study # 2

Case Study #2Post ContrastCase Study # 333 year old maleIleocolic Crohns disease with perianal diseaseIncreasing bowel symptoms with pain and diarrhoea

Case Study # 3

Case Study # 443 year old maleCrohns disease involving the terminal ileumPrevious perineal fistulaIncreasing abdominal pain and bloody PR discharge?extent of small bowel disease?extent of perineal fistula

Case Study # 4

Case Study # 4

Case Study #528 year old femalePanproctocolectomy for FAPChronic abdominal pain and distensionCT without contrast showed no evidence of obstruction?subacute obstruction

Case Study #5SummaryAssessment of complex or recurrent Crohns diseaseHigh resolution multi-planar imagingIntra- and extra-luminal disease

Thank you