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1
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Charpentier C, Marion-Letellier R, Savoye G, Nicol L, Mulder P, Aziz M, Vera P, Déchelotte P, Savoye-Collet C. Magnetic resonance colonography in rats with TNBS-induced colitis: a feasibility and validation study. Inflamm Bowel Dis 2012; 18:1940-9. [PMID: 22262626 DOI: 10.1002/ibd.22897] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/03/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Magnetic resonance colonography (MRC) has been recently developed to assess bowel inflammation in inflammatory bowel disease (IBD) patients. Evaluating animal models of inflammation with MRC may be important in new drug-screening processes. The aim of this study was to assess the feasibility of MRC in colitic rats and confront it with model characteristics. METHODS Colitis was induced by rectal injection of trinitrobenzene-sulfonic acid (TNBS) in 13 rats while six rats received the vehicle. MRC was performed at day 2. Colon inflammation and production of inflammatory mediators were evaluated. Image quality was assessed by wall and motion artifacts. MRC criteria were bowel wall thickness, wall signal intensity on T2-weighted (T2w) and T1w images, the appearance of a target sign pattern, and irregular patterns of mucosal surface. RESULTS MRC quality was good or excellent in 16/21 examinations with no difference between groups. Colitis rats were significantly different from controls in terms of wall thickness (P = 0.004), the appearance of a target sign pattern (P = 0.02), irregular patterns of mucosal surface (P = 0.01), and hyperintensity on T1w images (P = 0.03). All MRC criteria except maximal bowel wall thickness were associated with colon weight:length ratio and inflammatory biomarkers (all P < 0.05). Minimal bowel wall thickness and wall signal intensity on T2w images were associated with histological score (P < 0.05). CONCLUSIONS MRC is feasible and reliable in rats with TNBS-induced colitis. MRC criteria including colon wall thickness, wall signal intensity on T2w images, hyperintensity in T1w sequence, and the appearance of a target sign pattern may be potential targets for new IBD drugs.
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Affiliation(s)
- Cloé Charpentier
- INSERM Unit U1073, Institute for Biomedical Research, Rouen University, Rouen, France
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2
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Mkpolulu CA, Ghobrial PM, Catanzano TM. Nontraumatic abdominal pain in pregnancy: imaging considerations for a multiorgan system problem. Semin Ultrasound CT MR 2012; 33:18-36. [PMID: 22264900 DOI: 10.1053/j.sult.2011.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Nontraumatic abdominal pain in the pregnant patient can present a clinician with a variety of diagnostic possibilities. The overlap between signs and symptoms expected in normal pregnancy and these many pathologic possibilities does little to help focus the clinician's diagnostic efforts. Fear of ionizing radiation's effects on the fetus has driven efforts to refine medical imaging algorithms in such a way as to attempt to eliminate its use at all cost. In today's world, we are nearly there. In this review the differential diagnosis of nontraumatic abdominal pain in the pregnant patient will be explored. Of note is the recurring theme that much of what can be done today with regard to diagnostic imaging, both in general and with regard to this specific subset of patients, centers on the use of the non-ionizing modalities of ultrasound and magnetic resonance imaging.
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Affiliation(s)
- Chiedozie A Mkpolulu
- Department of Radiology, Tufts School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
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Deeab DA, Dick E, Sergot AA, Sundblon L, Gedroyc W. Magnetic resonance imaging of the small bowel. Radiography (Lond) 2011. [DOI: 10.1016/j.radi.2010.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wiarda BM, Horsthuis K, Dobben AC, Geenen RWF, Heitbrink MA, Moolenaar W, Kuipers EJ, Stoker J. Magnetic resonance imaging of the small bowel with the true FISP sequence: intra- and interobserver agreement of enteroclysis and imaging without contrast material. Clin Imaging 2009; 33:267-73. [PMID: 19559348 DOI: 10.1016/j.clinimag.2008.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 11/03/2008] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to determine the reliability of magnetic resonance imaging (MRI) without luminal contrast medium versus MR enteroclysis for evaluating small bowel pathology, to compare MRI and MRE findings per observer, and to compare these findings with those of an expert reader in order to determine the influence of luminal contrast medium on morphological evaluations. CONCLUSION The use of luminal contrast medium bowel improves reliability for measuring bowel wall thickness and for the diagnosis and grading of obstruction when evaluating the small bowel.
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Affiliation(s)
- Bart M Wiarda
- Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands.
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5
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Herfarth HH, Grunert M, Klebl F, Strauch U, Feuerbach S, Schölmerich J, Rogler G, Schreyer AG. Frequency and nature of incidental extra-enteric lesions found on magnetic resonance enterography (MR-E) in patients with inflammatory bowel diseases (IBD). PLoS One 2009; 4:e4863. [PMID: 19337373 PMCID: PMC2659789 DOI: 10.1371/journal.pone.0004863] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 01/28/2009] [Indexed: 01/18/2023] Open
Abstract
Background The aim of this study was to determine the occurrence of extra-enteric findings in a large cohort of patients undergoing magnetic resonance enterography (MR-E) and to classify the clinical significance of these findings. Materials and Methods We retrospectively analyzed 1154 MR-E performed in 1006 patients referred to our radiological department between 1999–2005. The reasons for referral were suspected or proven inflammatory bowel diseases (IBD) (n = 710), further diagnostic work-up for small bowel disease because of non-specific abdominal symptoms (SBD; n = 182) or suspected small bowel malignancies (SBM; n = 114). All extra-enteric findings were reviewed by a radiologist and a gastroenterologist and were classified as having high, moderate, or low significance for further diagnostic or therapeutic procedures. Results The average age of all patients was 40±16 (Mean±SD) years (y) (IBD 35±13 y; SBD 49±16 y; SBM 57±15 y). A total of 1113 extra-enteric findings were detected in 600 of 1006 patients (59.6%). Of these findings 180 (16.2%) were judged as having a high, 212 (19.0%) a moderate and 721 (64.8%) a low significance. On a per group basis in patients with IBD 12.0% of the findings were of major clinical significance compared to 13.7% and 33.3% in patients with SBD and SBM, respectively. The most common major findings were abscesses (69.9%) in the IBD group and extraintestinal tumors, metastases or masses in the SBD and SBM groups (41.9% and 74.2%, respectively). Conclusions MR-E reveals a substantial number of extra-enteric findings, supporting the role of a cross-sectional imaging method for the evaluation of the small bowel.
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Affiliation(s)
- Hans H Herfarth
- Department of Internal Medicine, University of Regensburg, Regensburg, Germany.
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6
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MRI of small bowel Crohn's disease: determining the reproducibility of bowel wall gadolinium enhancement measurements. Eur Radiol 2009; 19:1960-7. [PMID: 19308416 DOI: 10.1007/s00330-009-1371-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 02/11/2009] [Accepted: 02/14/2009] [Indexed: 01/18/2023]
Abstract
This study aims to determine inter- and intra-observer variation in MRI measurements of relative bowel wall signal intensity (SI) in Crohn's disease. Twenty-one small bowel MRI examinations (11 male, mean age 40), including T1-weighted acquisitions acquired 30 to 120s post-gadolinium, were analysed. Maximal bowel wall SI (most avid, conspicuous contrast enhancement) in designated diseased segments was measured by two radiologists and two trainees using self-positioned "free" regions of interest (ROIs) followed by "fixed" ROIs chosen by one radiologist, and this procedure was repeated 1 month later. Relative enhancement (post-contrast SI minus pre-contrast SI/pre-contrast SI) was calculated. Data were analysed using Bland-Altman limits of agreement and intra-class correlation. Inter-observer agreement for relative enhancement was poor (spanning over 120%) using a free ROI-95% limits of agreement -0.69, 0.70 and -0.47, 0.74 for radiologists and trainees, respectively, only marginally improved by use of a fixed ROI -0.60, 0.67 and -0.59, 0.49. Intra-class correlation ranged from 0.46 to 0.72. Intra-observer agreement was slightly better and optimised using a fixed ROI-95% limits of agreement -0.52, 0.50 and -0.34, 0.28 for radiologists and trainees, respectively. Intra-class correlation ranged from 0.49 to 0.86. Relative bowel wall signal intensity measurements demonstrate wide limits of observer agreement, unrelated to reader experience but improved using fixed ROIs.
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7
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Knuesel PR, Kubik RA, Crook DW, Eigenmann F, Froehlich JM. Assessment of dynamic contrast enhancement of the small bowel in active Crohn's disease using 3D MR enterography. Eur J Radiol 2009; 73:607-13. [PMID: 19131201 DOI: 10.1016/j.ejrad.2008.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 11/28/2008] [Accepted: 12/01/2008] [Indexed: 12/18/2022]
Abstract
PURPOSE To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE). MATERIALS AND METHODS Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination=VIBE) data sets were obtained pre-contrast and 20-40s, 60-80s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR). RESULTS Small bowel wall enhancement was significantly higher (p<0.05) in inflamed compared to normal segments at 20-40s (SNR inflamed: 58.7+/-33.8 vs normal: 36.0+/-19.8; p=0.048; CNR inflamed: 34.8+/-23.4 vs normal: 16.3+/-11.2; p=0.017) and at 60-80s (SNR: 60.3+/-25.1 vs 41.9+/-20.0; p=0.049; CNR: 34.9+/-15.1 vs 19.3+/-13.2; p=0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7+/-16.0 vs 18.1+/-13.2; p=0.04), while differences in SNR did not attain statistical significance (63.0+/-26.2 vs 45.3+/-23.3; p=0.15). CONCLUSION In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.
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Affiliation(s)
- Patrick R Knuesel
- Department of Radiology, Kantonsspital Baden, CH-5404 Baden, Switzerland
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8
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Sinha R, Murphy P, Hawker P, Sanders S, Rajesh A, Verma R. Role of MRI in Crohn's disease. Clin Radiol 2008; 64:341-52. [PMID: 19264177 DOI: 10.1016/j.crad.2008.08.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/18/2008] [Accepted: 08/20/2008] [Indexed: 12/18/2022]
Abstract
The traditional imaging of Crohn's disease has relied on barium and computed tomography (CT) examinations. In recent years magnetic resonance imaging (MRI) has emerged as an imaging method that can be used in the diagnosis and assessment of Crohn's disease. The advantages of MRI include lack of ionizing radiation and its superior tissue contrast resolution. The clinical progression of Crohn's disease can be variable, and MRI can be used to assess inflammatory status, disease progression, and complications of Crohn's disease. MRI of the small bowel is an evolving technique and it has the potential to become the preferred technique for imaging of small bowel Crohn's disease in the future.
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Affiliation(s)
- R Sinha
- Department of Radiology, GI Unit, South Warwickshire NHS Trust, & IBD Network, Coventry & South Warwickshire, United Kingdom.
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Kinner S, Kuehle CA, Herbig S, Haag S, Ladd SC, Barkhausen J, Lauenstein TC. MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast? Eur Radiol 2008; 18:2542-8. [PMID: 18500525 DOI: 10.1007/s00330-008-1041-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Accepted: 03/10/2008] [Indexed: 01/09/2023]
Abstract
Sufficient luminal distension is mandatory for small bowel imaging. However, patients often are unable to ingest volumes of currently applied oral contrast compounds. The aim of this study was to evaluate if administration of low doses of an oral contrast agent with high-osmolarity leads to sufficient and diagnostic bowel distension. Six healthy volunteers ingested at different occasions 150, 300 and 450 ml of a commercially available oral contrast agent (Banana Smoothie Readi-Cat, E-Z-EM; 194 mOsmol/l). Two-dimensional TrueFISP data sets were acquired in 5-min intervals up to 45 min after contrast ingestion. Small bowel distension was quantified using a visual five-grade ranking (5 = very good distension, 1 = collapsed bowel). Results were statistically compared using a Wilcoxon-Rank test. Ingestion of 450 ml and 300 ml resulted in a significantly better distension than 150 ml. The all-over average distension value for 450 ml amounted to 3.4 (300 ml: 3.0, 150 ml: 2.3) and diagnostic bowel distension could be found throughout the small intestine. Even 45 min after ingestion of 450 ml the jejunum and ileum could be reliably analyzed. Small bowel imaging with low doses of contrast leads to diagnostic distension values in healthy subjects when a high-osmolarity substance is applied. These findings may help to further refine small bowel MRI techniques, but need to be confirmed in patients with small bowel disorders.
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Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
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11
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Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008; 247:64-79. [PMID: 18372465 DOI: 10.1148/radiol.2471070611] [Citation(s) in RCA: 421] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare, by performing a meta-analysis, the accuracies of ultrasonography (US), magnetic resonance (MR) imaging, scintigraphy, computed tomography (CT), and positron emission tomography (PET) in the diagnosis of inflammatory bowel disease (IBD). MATERIALS AND METHODS MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched for studies on the accuracy of US, MR imaging, scintigraphy, CT, and PET, as compared with a predefined reference standard, in the diagnosis of IBD. Sensitivity and specificity estimates were calculated on per-patient and per-bowel-segment bases by using a bivariate random-effects model. RESULTS Thirty-three studies, from a search that yielded 1406 articles, were included in the final analysis. Mean sensitivity estimates for the diagnosis of IBD on a per-patient basis were high and not significantly different among the imaging modalities (89.7%, 93.0%, 87.8%, and 84.3% for US, MR imaging, scintigraphy, and CT, respectively). Mean per-patient specificity estimates were 95.6% for US, 92.8% for MR imaging, 84.5% for scintigraphy, and 95.1% for CT; the only significant difference in values was that between scintigraphy and US (P = .009). Mean per-bowel-segment sensitivity estimates were lower: 73.5% for US, 70.4% for MR imaging, 77.3% for scintigraphy, and 67.4% for CT. Mean per-bowel-segment specificity estimates were 92.9% for US, 94.0% for MR imaging, 90.3% for scintigraphy, and 90.2% for CT. CT proved to be significantly less sensitive and specific compared with scintigraphy (P = .006) and MR imaging (P = .037) CONCLUSION No significant differences in diagnostic accuracy among the imaging techniques were observed. Because patients with IBD often need frequent reevaluation of disease status, use of a diagnostic modality that does not involve the use of ionizing radiation is preferable.
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Affiliation(s)
- Karin Horsthuis
- Departments of Radiology and Nuclear Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
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12
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Paolantonio P, Tomei E, Rengo M, Ferrari R, Lucchesi P, Laghi A. Adult celiac disease: MRI findings. ACTA ACUST UNITED AC 2008; 32:433-40. [PMID: 16967239 DOI: 10.1007/s00261-006-9089-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The purpose of our report is to describe a spectrum of findings of celiac disease at MR enterography. MR enterography is a non-invasive, feasible, and reproducible imaging technique for the evaluation of small bowel. Findings on MR enterography, similar to those of conventional barium studies, may suggest a diagnosis of celiac disease.
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Affiliation(s)
- Pasquale Paolantonio
- Department of Radiological Sciences, University of Rome La Sapienza, PoloPontino, Latina, Italy.
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Cine Magnetic Resonance Imaging Evaluation of Peristalsis of Small Bowel With Longitudinal Ulcer in Crohn Disease. J Comput Assist Tomogr 2007; 31:876-83. [DOI: 10.1097/rct.0b013e31804b1a26] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
The objective of this review is to demonstrate magnetic resonance imaging as an important adjunct to ultrasound and computed tomography in the evaluation of the pregnant patient with abdominal pain. With the advent of ultrafast T2-weighted pulse sequences, fetal and bowel motion cause minimal artifact on the images. An accurate diagnosis can often be made in a few minutes based on these high-contrast images performed in 2 or 3 planes. T1-weighted gradient echo images with and without fat saturation are useful for identifying blood and fat, especially in the case of adnexal masses. Gadolinium-diethylenetriamine pentaacetic acid is rarely used to diagnose inflammatory or obstructive disease and is reserved for those patients with suspected malignancies.
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Affiliation(s)
- Julia R Fielding
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn's disease in the small bowel: Prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 2006; 16:2817-27. [PMID: 16799782 DOI: 10.1007/s00330-006-0338-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2005] [Revised: 04/28/2006] [Accepted: 05/09/2006] [Indexed: 02/06/2023]
Abstract
Our objective was to assess the diagnostic value of magnetic resonance enteroclysis (MRE) compared with conventional enteroclysis (CE) in patients with Crohn's disease. A secondary objective was to evaluate the diagnostic accuracy of each different MR sequence. Sixty-six consecutive patients with known Crohn's disease underwent MRE and CE. Fast imaging employing steady-state acquisition (FIESTA), single-shot fast spin-echo (ssFSE), and contrast-enhanced T1-weighted sequences were assessed by two radiologists who reached a consensus about the following findings: visualization of wall ulcers, pseudopolyps, fistulae, mural stenosis, and mesenteric abnormalities. Standard descriptive statistics and the McNemar test were used. The sensitivity, specificity and accuracy of MRE were 90-87% and 83% for the depiction of parietal ulcers, 84%-88% and 86% for pseudopolyps, 100-94% and 96% for mural stenosis, 93-100% and 94% for fistulae. The number of detected extraluminal findings was significantly higher with MRE (P < 0.01). The accuracy of FIESTA sequence was statistically higher in the depiction of wall ulcers and fistulae than that of three-dimensional fast spoiled gradient echo (3D-FSPGR) (P < 0.01) and ssFSE (P < 0.05) sequences. Contrast-enhanced 3D-FSPGR was superior for mural stenosis visualization compared to ssFSE (P < 0.05) and FIESTA (P < 0.05). MRE correlates accurately with CE in the detection of superficial and transmural abnormalities and has the advantage of assessing the mesenteric manifestations.
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Affiliation(s)
- Gabriele Masselli
- Radiology DEA Department, Umberto I Academic Hospital, University La Sapienza, Viale del Policlinico, 155-00161 Rome, Italy.
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Haykir R, Karakose S, Karabacakoglu A, Sahin M, Kayacetin E. Three-dimensional MR and axial CT colonography versus conventional colonoscopy for detection of colon pathologies. World J Gastroenterol 2006; 12:2345-50. [PMID: 16688823 PMCID: PMC4088068 DOI: 10.3748/wjg.v12.i15.2345] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the sensitivity and specificity of MR colonography (MRC) and CT performance in detecting colon lesions, and to compare their sensitivity and specificity with that of conventional colonoscopy.
METHODS: Forty-two patients suspected of having colonic lesions, because of rectal bleeding, positive fecal occult blood test results or altered bowel habits, underwent the examinations. After insertion of a rectal tube, the colon was filled with 1000-1500 mL of a mixture of 9 g/L NaCl solution, 15-20 mL of 0.5 mmol/L gadopentetate dimeglumine and 100 mL of iodinized contrast material. Once colonic distension was achieved, three-dimensional gradient-echo (3D-GRE) sequences for MR colonography and complementary MR images were taken in all cases. Immediately after MR colonography, abdominal CT images were taken by spiral CT in the axial and supine position. Then all patients were examined by conventional colonoscopy (CC).
RESULTS: The sensitivity and specificity of MRC for colon pathologies were 96.4% and 100%, respectively. The percentage of correct diagnosis by MRC was 97.6%. The sensitivity and specificity of CT for colon pathologies were 92.8%, 100%, respectively. The percentage of correct diagnosis by CT was 95.2%.
CONCLUSION: In detecting colon lesions, MRC achieved a diagnostic accuracy similar to CC. However, MRC is minimally invasive, with no need for sedation or analgesics during investigation. There is a lower percentage of perforation risk, and all colon segments can be evaluated due to multi-sectional imaging availability; intramural, extra-intestinal components of colonic lesions, metastasis and any additional lesions can be evaluated easily. MRC and CT colonography are new radiological techniques that promise to be highly sensitive in the detection of colorectal mass and inflammatory bowel lesions.
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Affiliation(s)
- Rahime Haykir
- Department of Radiology, Selcuk University Meram Medical Faculty, Konya 42080, Turkey
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Brown MA, Birchard KR, Semelka RC. Magnetic resonance evaluation of pregnant patients with acute abdominal pain. Semin Ultrasound CT MR 2005; 26:206-11. [PMID: 16152735 DOI: 10.1053/j.sult.2005.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acute abdominal pain in a pregnant patient is associated with a long differential diagnosis, and diagnostic imaging is often required to guide management. Ultrasound is safe and widely available; however, maternal structures may be difficult to evaluate during pregnancy due to anatomic changes. Computed tomography is accurate but exposes the fetus to ionizing radiation. Magnetic resonance (MR) imaging provides excellent anatomic resolution and tissue characterization without ionizing radiation, and MR diagnosis frequently requires no contrast administration. Using an appropriate combination of sequences, MR imaging can reliably demonstrate many causes of acute abdominal pain during pregnancy.
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Affiliation(s)
- Michèle A Brown
- Department of Radiology, Hospital of the University of California, San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA.
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Abstract
Technological developments have extended the role of MRI in the evaluation of the gastrointestinal tract. The potential of MRI to evaluate disease activity in Crohn's disease has been investigated extensively, as MRI has intrinsic advantages over other techniques, including noninvasiveness and the absence of ionizing radiation. For perianal fistulizing disease MRI has become a mainstay in evaluation of disease, as localization and extent of disease can be very well appreciated using both T2-weighted and T1-weighted sequences, fat suppression, and intravenous contrast medium. Imaging of the small bowel and colon in Crohn's disease is more complicated due to bowel peristalsis and respiratory movement. However, using fast breathhold sequences and intravenous spasmolytic medication, images of good diagnostic quality can be acquired. To obtain sufficiently distended bowel, which in our estimation is a prerequisite for evaluation of the bowel, MR enteroclysis can be performed. However, applicability of different oral contrast media has been studied, as a noninvasive method for bowel distension would be preferable. Abdominal MRI is a valuable imaging technique for evaluation of luminal, transmural, and extraintestinal manifestations of Crohn's disease as degree of disease activity, presence of luminal pathology (e.g., stenoses), and extraintestinal manifestations of disease (e.g., abscesses, fistulas) can be accurately assessed.
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Affiliation(s)
- Karin Horsthuis
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands.
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Korman U, Kurugoglu S, Ogut G. Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging. ACTA ACUST UNITED AC 2005; 30:564-75. [PMID: 16132433 DOI: 10.1007/s00261-005-0331-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- U Korman
- Cerrahpasa Medical Faculty, Department of Radiology, Istanbul University, Kocamustafapasa, Istanbul 34300, Turkey.
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Abstract
MR imaging, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. The optimal study technique is debatable, although the oral administration of contrast material as a first-line approach is less expensive, faster, easier to perform, and better tolerated by patients. MR enteroclysis might be reserved for selected cases as a second-line study. The major clinical indication is the evaluation of patients who have suspected or known Crohn's disease. The absence of ionizing radiation, considering the young age of most of the patients and the frequency of the examinations, is an important advantage over other techniques (radiograph and CT enteroclysis).
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Affiliation(s)
- Andrea Laghi
- Department of Radiological Sciences, University of Rome La Sapienza, Polo Didattico Pontino - I.C.O.T., Latina, Via Franco Faggiana 34, 04100 Latina, Italy.
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Pilleul F, Godefroy C, Yzebe-Beziat D, Dugougeat-Pilleul F, Lachaux A, Valette PJ. Magnetic resonance imaging in Crohn's disease. ACTA ACUST UNITED AC 2005; 29:803-8. [PMID: 16294149 DOI: 10.1016/s0399-8320(05)86351-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To evaluate the value of gadolinium enhanced MRI with oral opacification using a 5% mannitol solution (CE-Mannitol-MRI) to reveal bowel inflammation in pediatric patients with known or suspected Crohn's disease (CD). MATERIALS AND METHODS Sixty-two consecutive children (median age 13.9 years) with known or suspected CD underwent ileocolonoscopy with biopsy, ultrasonography and CE-Mannitol-MRI. CD activity was measured with the Pediatric Crohn's Disease Activity Index (PCDAI). Image quality, wall thickness, bowel wall enhancement and complications identified on CE-Mannitol-MRI were evaluated by two blinded radiologists. RESULTS The sensitivity and specificity of CE-Mannitol-MRI for the diagnosis of CD were 83% and 100%, respectively. Bowel wall enhancement was higher in the group of patients with abnormal small bowel loops versus control group (P = 0.001). In patients with known CD, there was a positive correlation between wall thickness and PCDAI (P = 0.003). However, no significant correlation was demonstrated between parietal contrast enhancement and PCDAI (P = 0.497). CE-Mannitol-MRI enabled identification of complications in 18 patients (9 fistulae, 8 strictures and 1 intussusception). CONCLUSION In pediatric patients with CD, CE-Mannitol-MRI contributes significantly to the identification of disease extension, severity and intestinal complications with adequate diagnostic accuracy. This technique could also be useful as the first line diagnostic exploration in young patients with suspected CD.
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Affiliation(s)
- Frank Pilleul
- Département d'Imagerie Digestive, Centre Hospitalo-Universitaire E. Herriot, Lyon.
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Sempere GAJ, Martinez Sanjuan V, Medina Chulia E, Benages A, Tome Toyosato A, Canelles P, Bulto A, Quiles F, Puchades I, Cuquerella J, Celma J, Orti E. MRI evaluation of inflammatory activity in Crohn's disease. AJR Am J Roentgenol 2005; 184:1829-35. [PMID: 15908538 DOI: 10.2214/ajr.184.6.01841829] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We wanted to assess the capability of MRI to quantitatively evaluate the therapeutic response to Crohn's disease (CD) relapse. SUBJECTS AND METHODS Twenty patients with histologically proven CD were prospectively evaluated with MRI and ileocolonoscopy over a 2-year period. The MRI protocol included axial and coronal T2-weighted and contrast-enhanced T1-weighted sequences. MRI examinations were performed twice, once during an acute relapse of CD and the other at clinical remission. The terminal ileum and colon were divided into six segments/patient, and the endoscopy and histology findings were considered the standard of reference. These were compared on a segmental basis with the quantitative MRI findings regarding wall thickness and contrast enhancement. The results obtained in active and remission CD phases were likewise compared with the findings in 10 control subjects who underwent complete ileocolonoscopy for other reasons and had no pathological findings on ileocolonoscopy. RESULTS Fifty three of 120 (44.2%) bowel segments showed pathologic changes on endoscopy and histology consistent with CD in active phase. On changing from the active disease phase to clinical remission, a significant decrease was observed in the wall thickness and contrast enhancement of the affected bowel wall. In the active phase of CD, the pathologic bowel segments presented with significantly greater contrast enhancement and wall thickness values compared with the healthy segments of CD and controls. On converting clinically into remission, contrast enhancement tended to normalize, whereas bowel wall thickness remained increased compared with the controls. CONCLUSION MRI is able to detect pathologic bowel segments in CD, as it allows the measurement of significant variations in wall thickness and contrast enhancement on changing from the active phase of the disease to remission.
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Affiliation(s)
- G A Javier Sempere
- Servicio Patologia Digestiva, Hospital General Universitario de Valencia, Valencia, Spain
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Akman C, Korman U, Oğüt G, Kuruğoğlu S, Urger E, Ulus S, Esen G, Tasci I. A combination of small bowel imaging methods: conventional enteroclysis with complementary magnetic resonance enteroclysis. Clin Radiol 2005; 60:778-86. [PMID: 15978889 DOI: 10.1016/j.crad.2005.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 01/24/2005] [Accepted: 02/21/2005] [Indexed: 12/11/2022]
Abstract
AIM The aim of this prospective study was to evaluate the overall findings of conventional enteroclysis (CE) with complementary magnetic resonance enteroclysis (MRE) in small bowel disease. METHODS The study included 32 patients referred from various clinical departments, with known or suspected small bowel disease and abnormalities on CE. Immediately after CE, true fast imaging with steady-state precession (true FISP), and unenhanced and gadolinium-enhanced T1-weighted fast low-angle shot (FLASH) sequences with fat saturation were obtained. Mucosal, mural and luminal changes of the small bowel were evaluated by each technique. In addition, bowel wall thickening, bowel wall enhancement and perienteric changes were assessed by MRE. The radiological findings obtained were evaluated together as a combination, and the role of MRE in the determination of the activity and complications of the small bowel disease was assessed. Radiological findings were correlated with clinical evaluation and follow-up in all cases, including endoscopy in 14 cases and surgery in 5 cases. RESULTS MRE provided important supplementary mural and extramural information, including degree of pathological wall thickness, mural enhancement pattern associated with disease activity, perivisceral collection, abscess formation, mesenteric fibrofatty proliferation, lymphadenopathy and increase in perienteric vascularity. Short strictures were not revealed on MRE; however, for patients with a history of abdominal malignancy, MRE helped characterize the level of any obstruction and the extent of the disease. CONCLUSION We recommend MRE for patients who have findings of advanced inflammatory bowel disease or neoplasm on CE examination. The combination of these two techniques can provide important information on the degree and extent of the disorder.
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Affiliation(s)
- C Akman
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Birchard KR, Brown MA, Hyslop WB, Firat Z, Semelka RC. MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol 2005; 184:452-8. [PMID: 15671363 DOI: 10.2214/ajr.184.2.01840452] [Citation(s) in RCA: 195] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to show the usefulness of MRI in the evaluation of pregnant women with acute abdominal or pelvic pain. SUBJECTS AND METHODS All MRI studies of pregnant patients who were referred for examination because of acute abdominal or pelvic pain between June 2002 and May 2004 were included in this study (n=29). The use of MRI was at the discretion of the clinician. Fetal sonography was performed in all patients before any other imaging. A complete abdominal sonographic examination was performed in six patients before MRI. In the remaining 23 patients, MRI was the choice for primary imaging. Multiplanar multisequence MR images of the abdomen and pelvis were obtained in each patient. Unenhanced images were reviewed by an experienced radiologist to determine whether a diagnosis could be made without the administration of gadolinium. In 22 of 29 studies, gadolinium was not administered. The prospective clinical MR interpretations were compared with follow-up medical, surgical, and obstetric records to determine the correctness of the interpretation. All patients were followed up until the date of article submission or until the date of final chart entry. RESULTS Correlation of prospective clinical MR interpretations with follow-up medical records showed correct identification of disease entities in all but one patient. In one patient, torsion of the ovary was neither described prospectively nor seen in retrospect. The following disease processes were correctly identified using MRI: appendiceal abscess (n=1), appendicitis (n=2), intraabdominal and rectus muscle abscess (n=1), intussusception (n=1), pancreatitis (n=1), ulcerative colitis (n=1), Crohn's disease with diffuse peritoneal inflammation (n=1), bilateral adrenal hemorrhage (n=1), pyelonephritis (n=2), hydronephrosis (n=1), uterine fibroid degeneration (n=2), degeneration and torsion of a submucosal uterine fibroid (n=1), simple ovarian cysts (n=1), and ovarian torsion (n=1). Twelve of the 29 patients had normal findings on MR examinations and unremarkable follow-up. CONCLUSION The intrinsic safety of MRI and its ability to accurately show abdominal and pelvic disease in pregnant patients make it highly useful in the evaluation of these patients.
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Affiliation(s)
- Katherine R Birchard
- Department of Radiology, University of North Carolina Hospitals, 101 Manning Dr., 2006 Old Clinic Bldg., Chapel Hill, NC 27599-7510, USA
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25
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Ajaj W, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Dose optimization of mannitol solution for small bowel distension in MRI. J Magn Reson Imaging 2005; 20:648-53. [PMID: 15390230 DOI: 10.1002/jmri.20166] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To optimize the dose of a hydro solution containing 2.5% mannitol and 0.2% locust bean gum (LBG) for small bowel MRI in terms of bowel distension and patient acceptance. MATERIALS AND METHODS A total of 10 healthy volunteers ingested a hydro solution containing 2.5% mannitol and 0.2% LBG. Four different volumes (1500, 1200, 1000, and 800 ml) were assessed on four different examination days. Small bowel distension was quantified on coronal two-dimensional TrueFISP images by measuring the diameter of eight bowel loops throughout the jejunum and the ileum. In addition, volunteer acceptance was evaluated for every single examination by using a questionnaire. RESULTS Optimal distension was obtained with either, 1000, 1200, or 1500 ml, with no statistically significant differences in distension between these groups. Administration of 800 ml led to significantly less distension of the small bowel. Significantly less side effects were noted using either 800 or 1000 ml compared to using larger volumes. CONCLUSION We recommend a dose of 1000 ml mannitol/LBG solution as an oral contrast agent for optimal bowel distension and minimal side effects.
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Affiliation(s)
- Waleed Ajaj
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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Martin DR, Danrad R, Herrmann K, Semelka RC, Hussain SM. Magnetic resonance imaging of the gastrointestinal tract. Top Magn Reson Imaging 2005; 16:77-98. [PMID: 16314698 DOI: 10.1097/01.rmr.0000179461.55234.7d] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Comprehensive bowel examination results from the combined use of T2-weighted single-shot and breath hold T1-weighted gradient echo, minus/plus fat suppression, and gadolinium-enhanced 3D gradient echo (3D VIBE, T1 FAME, 3D THRIVE). Gadolinium-enhanced imaging should be performed dynamically, but the venous 60- to 90-second delayed phase images with fat suppression are generally the most valuable. Removal of fat signal for detection of enhancing normal and abnormal structures is critical. Newly available True-FISP (FIESTA, BFFE) sequences obtained in the 2D form can be very helpful in delineation of bowel wall pathology and overall bowel anatomy, particularly when combined with a water-based intraluminal distending agent. Advantages include rapid acquisition, high signal-to-noise, and motion insensitivity. Generalized protocol for comprehensive evaluation of the entire abdomen and pelvis can be used for the following bowel indications: type and severity of inflammatory bowel disease (IBD); identifying enteric abscesses and fistulae; preoperative staging of malignant neoplasms, including rectal carcinoma; differentiating postoperative and radiation therapy changes from recurrent carcinoma; follow-up evaluation of metastases response to localized ablative or systemic chemotherapy. For improved visualization of bowel wall in dedicated examinations, bowel distension should be achieved using either orally or rectally delivered contrast agents to produce either bright or dark lumen. We have found 2D True-FISP without fat suppression superior to 3D True-FISP and to single-shot echo-train sequences to provide a T2-weighted image of bowel morphology. Strengths include: performed without fat suppression results in the very dark bowel wall being sandwiched between intermediate high signal fat adjacent to bowel serosa, and very high lumen signal from water-distending agent; 2D True-FISP provides motion insensitivity that is lost if 3D is used; True-FISP produces better edge sharpness than single-shot echo-train, higher contrast, and resists flow void artifacts commonly seen with single-shot echo-train imaging combined with a water distending agent. Drawbacks of this technique include: artifacts related to extreme sensitivity to field inhomogeneity, including air-soft tissue interfaces at the patient skin surface, and from retained bowel gas; retained bowel gas is dark against dark bowel wall, impairing bowel wall assessment; and True-FISP does not provide sensitivity for edema, which is superior on single-shot echo-train imaging. Small/large bowel indications for MRI include: inflammatory bowel disease, infectious disease including abscess evaluation or for appendicitis, inflammatory conditions including ischemia, and partial obstruction, malnutrition, and neoplasm search.
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Affiliation(s)
- Diego R Martin
- Emory University School of Medicine, Department of Radiology, 3164 Clifton Rd, Atlanta, GA 30322, USA.
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27
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Schreyer AG, Geissler A, Albrich H, Schölmerich J, Feuerbach S, Rogler G, Völk M, Herfarth H. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn's disease. Clin Gastroenterol Hepatol 2004; 2:491-7. [PMID: 15181618 DOI: 10.1016/s1542-3565(04)00168-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Diagnostic results of magnetic resonance (MR) enteroclysis correlate highly with those from conventional enteroclysis; nevertheless, intubation of the patient and positioning of an intestinal tube is still necessary for the examination, which is often remembered as the most embarrassing part of the examination by the patient. A more comfortable and highly sensitive examination of the small bowel therefore would increase patient acceptance for recurring examinations, which are often necessary, for example, in patients with Crohn's disease. This study evaluates the diagnostic efficacy of abdominal MR imaging (MRI) of the small bowel after drinking contrast agent only compared with conventional enteroclysis and abdominal MRI performed after enteroclysis in patients with suspected or proven Crohn's disease. METHODS Twenty-one patients with Crohn's disease referred for conventional enteroclysis underwent abdominal MRI after enteroclysis. Additionally, 1 to 3 days before or after these examinations, abdominal MRI was performed using only orally administered contrast. All MRI examinations were performed using a 1.5T scanner. RESULTS All pathological findings on conventional enteroclysis were shown correctly with MRI after enteroclysis and MRI after oral contrast only. Additional information by MRI was obtained in 6 of 21 patients. No statistically significant differences were found in assessing the diagnostic efficacy of the 3 examinations. CONCLUSIONS Abdominal MRI with oral contrast only can be used as a diagnostic tool for evaluation of the small bowel in patients with Crohn's disease and has the potential to replace conventional enteroclysis as follow-up.
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Schreyer AG, Seitz J, Feuerbach S, Rogler G, Herfarth H. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD) AU1. Inflamm Bowel Dis 2004; 10:45-54. [PMID: 15058527 DOI: 10.1097/00054725-200401000-00008] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Radiologic imaging--especially of the small bowel--plays an important role in the diagnosis and management of patients with inflammatory bowel disease. The radiographic examination of the small intestine with barium either as enteroclysis or as small bowel follow through are still the mainstays in small bowel imaging. However, abdominal CT or MRI, which has the advantage of not utilizing ionizing radiation, or the techniques of CT- or MR-enteroclysis, are overall comparable with regard to the sensitivity and specificity in detecting intestinal pathologies and have already replaced the conventional techniques in centers dedicated to the management of inflammatory bowel disease. Additionally, these cross-sectional imaging techniques provide, in a sense, a "one stop abdominal imaging workup," the diagnosis of extraluminal disease manifestations or complications. Future developments of CT- or MR-based virtual colonography and endoscopy in patients with inflammatory bowel disease are currently being investigated, but should momentarily be considered as purely experimental approaches.
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30
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Lauenstein TC, Schneemann H, Vogt FM, Herborn CU, Ruhm SG, Debatin JF. Optimization of oral contrast agents for MR imaging of the small bowel. Radiology 2003; 228:279-83. [PMID: 12750457 DOI: 10.1148/radiol.2281020161] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Effect on small-bowel distention of additives to water as contrast agents for magnetic resonance (MR) imaging was assessed. Oral contrast agents included water and water in combination with mannitol, a bulk fiber laxative, locust bean gum, and a combination of mannitol and locust bean gum. Filling of the small bowel was quantified on coronal images obtained with two-dimensional true fast imaging with steady-state precession sequence; bowel diameters were measured. Ingestion of water with locust bean gum and mannitol provided the best distention of the small bowel. MR imaging of the small bowel with oral administration of water can be improved with addition of osmotic and nonosmotic substances that lead to decreased water resorption.
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Affiliation(s)
- Thomas C Lauenstein
- Department of Diagnostic Radiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.
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Abstract
Colorectal cancer screening has vast potential. Beyond considerations for cost and diagnostic accuracy, the effectiveness of any colorectal screening strategy will be dependent on the degree of patient acceptance. Magnetic resonance (MR) colonography has been shown to be accurate regarding the detection of clinically relevant colonic polyps exceeding 10 mm in size, with reported sensitivity and specificity values exceeding 95%. To further increase patient acceptance, strategies for fecal tagging have recently been developed. By modulating the signal of fecal material to be identical to the signal characteristics of the enema applied to distend the colon, fecal tagging in conjunction with MR colonography obviates the need for bowel cleansing. The review will describe the techniques underlying MR colonography and describe early clinical experience with fecal tagging techniques.
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Affiliation(s)
- J F Debatin
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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Maglinte DDT, Gourtsoyiannis N, Rex D, Howard TJ, Kelvin FM. Classification of small bowel Crohn's subtypes based on multimodality imaging. Radiol Clin North Am 2003; 41:285-303. [PMID: 12659339 DOI: 10.1016/s0033-8389(02)00117-3] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This article has reviewed the imaging features that correspond to and support the classification of patients into clinical subtypes of Crohn's disease. One study showed that radiologic features on barium studies closely correlated with the Crohn's Disease Activity Index, and another study indicated that CT findings changed patient management in up to 29% of cases. Knowledge of the location, severity, and presence of complications assist in providing patients with appropriate treatment options. Reports of radiologic studies in Crohn's disease should include the presence or absence of imaging features that support these different subtypes. An additional advantage of the use of a reproducible imaging classification that emphasizes morphologic features would be improved comparison of the results of different investigators and treatment protocols. Whatever method of radiologic investigation is employed, it should be targeted to answer questions relevant to patient management. The imaging modalities used should be able to classify the small bowel Crohn's subtypes and should be reflected in the radiologists' reports.
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Affiliation(s)
- Dean D T Maglinte
- Department of Radiology, Indiana University School of Medicine, University Hospital and Outpatient Center, 550 North University Boulevard, Room 0279, Indianapolis, IN 46202-5253, USA.
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Abstract
MR enteroclysis provides adequate image quality and sufficient distention of the entire small bowel. The functional information provided by MR enteroclysis equals that provided by conventional enteroclysis, which implies the ability reliably to depict even low-grade SBO. The inherent advantages of enteroclysis over conventional enteroclysis are the potential to detect extraluminal pathologic conditions and the ability to provide detailed information about the wall of the small bowel and the entire abdomen. Unlike conventional enteroclysis, MR enteroclysis does not have problems with overlapping bowel loops. MR enteroclysis has the potential to be an excellent diagnostic method for examinations of small bowel disease because of the functional information, the soft tissue contrast, and multiplanar imaging capabilities.
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Affiliation(s)
- Heinz Werner Umschaden
- Department of Radiology, General Hospital Wolfsberg, Paul Hackhoferstrasse 9, 9400 Wolfsberg, Austria.
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Schreyer AG, Gölder S, Seitz J, Herfarth H. New diagnostic avenues in inflammatory bowel diseases. Capsule endoscopy, magnetic resonance imaging and virtual enteroscopy. Dig Dis 2003; 21:129-37. [PMID: 14571110 DOI: 10.1159/000073244] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The modalities for diagnostic imaging in patients with inflammatory bowel disease (IBD) have dramatically changed in the last decade. Several years ago the only methods to assess the small bowel were conventional enteroclysis or a small bowel 'follow through'. Nowadays, wireless capsule endoscopy as well as magnetic resonance imaging (MRI) with virtual endoscopy represent new evolving methods to depict and assess the small bowel. This article describes these recently introduced methods in the diagnostic assessment of the small bowel and discusses the clinical significance based on the current literature.
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35
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Ott DJ. MR imaging of Crohn's disease: what is the attraction? Am J Gastroenterol 2003; 98:211-2. [PMID: 12526963 DOI: 10.1111/j.1572-0241.2003.07218.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- David J Ott
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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36
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Abstract
Enteroclysis, the most detailed radiologic examination of the small bowel, can be a challenge for both patient and radiologist. This article broadly outlines the principal technical features of the standard enteroclysis procedure and discusses its diagnostic advantages and indications, as well as its limitations and difficulties. A comparative assessment of computed tomography-enteroclysis and the emerging magnetic resonance adaptation complements the survey of current approaches to radiologic small bowel diagnostics.
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Affiliation(s)
- Arunas E Gasparaitis
- Department of Radiology, University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL 60615, USA.
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37
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Low RN, Sebrechts CP, Politoske DA, Bennett MT, Flores S, Snyder RJ, Pressman JH. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology 2002; 222:652-60. [PMID: 11867781 DOI: 10.1148/radiol.2223010811] [Citation(s) in RCA: 133] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare T2-weighted breath-hold single-shot fast spin-echo (SE) and gadolinium-enhanced spoiled gradient-echo (GRE) MR imaging with contrast material administered orally and rectally for evaluating patients with Crohn disease. MATERIALS AND METHODS Twenty-eight patients with Crohn disease received 2% barium sulfate and water enema. The abdomen and pelvis were imaged with transverse and coronal single-shot fast SE and gadolinium-enhanced spoiled GRE MR imaging. Two radiologists reviewed the two types of images for bowel disease. The extent, severity, and conspicuity of the disease were determined. Proof of bowel disease at MR imaging was compared with that at endoscopy, barium study, and surgery. Statistical analysis was performed with the McNemar test. RESULTS Twenty-five of 28 patients had proven abnormal bowel segments. The per-patient sensitivity of gadolinium-enhanced spoiled GRE MR imaging for the two radiologists was 100% and 96% versus 60% and 60% (P <.05) with single-shot fast SE MR imaging. Gadolinium-enhanced spoiled GRE MR images depicted more segments (54 and 52 of 61 segments; sensitivity, 89% and 85%, respectively) of the diseased bowel than did single-shot fast SE MR images (31 and 32 of 61 segments; sensitivity, 51% and 52%, respectively; P <.001). Severity of Crohn disease was correctly depicted at gadolinium-enhanced spoiled GRE imaging in 93% of patients versus in 43% of patients at single-shot fast SE imaging. CONCLUSION In patients with Crohn disease, gadolinium-enhanced fat-suppressed spoiled GRE MR imaging better depicted the extent and severity of intestinal disease compared with single-shot fast SE imaging.
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Affiliation(s)
- Russell N Low
- Sharp and Children's MRI Center and Department of Radiology, Sharp Memorial Hospital, 7901 Frost St, San Diego, CA 92123, USA.
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Koh DM, Miao Y, Chinn RJ, Amin Z, Zeegen R, Westaby D, Healy JC. MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol 2001; 177:1325-32. [PMID: 11717076 DOI: 10.2214/ajr.177.6.1771325] [Citation(s) in RCA: 299] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the sensitivity and specificity of MR imaging in assessing the activity of Crohn's disease. SUBJECTS AND METHODS Thirty symptomatic patients with Crohn's disease but uncertain disease activity were prospectively examined using MR imaging. Twenty-nine patients were scored using the Crohn's disease activity index. Six hundred milliliters of water orally and 1 mg of glucagon intramuscularly were given before imaging. Breath-hold images were obtained using T2-weighted turbo spin-echo, T1-weighted fast low-angle shot, and fat-suppressed gadolinium-enhanced T1-weighted fast low-angle shot sequences. Images were assessed by two radiologists who were unaware of the patient's symptoms, clinical scoring, and other imaging tests, and who reached a consensus about the imaging findings (bowel wall thickening, bowel wall enhancement, and perienteric changes) and determined the absence or presence of active disease in each patient. MR imaging findings were correlated with endoscopy and surgery. RESULTS Twenty-three patients had active disease and seven patients had inactive disease. One hundred twenty-four of a total of 168 bowel segments were examined with both MR imaging and endoscopy or surgery. On a per patient basis, MR imaging had an overall sensitivity of 91% and a specificity of 71% for active disease. The Crohn's disease activity index had a sensitivity of 92% and a specificity of 28%. On a per segment basis, MR imaging had a sensitivity of 59% and a specificity of 93%. Bowel wall thickening of greater than 4 mm, bowel wall enhancement (ratio of signal intensity of abnormal to normal bowel > 1.3:1), and increased mesenteric vascularity were useful in identifying active disease. A layered enhancement pattern after the IV administration of gadolinium was highly specific for active inflammation. CONCLUSION MR imaging is useful in assessing the activity of Crohn's disease and may be helpful when clinical scoring is equivocal.
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Affiliation(s)
- D M Koh
- Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, United Kingdom
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Abstract
This review outlines technical advances in imaging of the small bowel. These include enhancement characteristics of normal bowel mucosa in computed tomography, contrast agents in magnetic resonance imaging, contrast ultrasonography, small-bowel transit measurements by radionuclide imaging, and enteroscopy. Subsequently, the application of these in clinical problem areas, including small-bowel obstruction, bleeding, and Crohn and celiac disease, will indicate the excellent potential of computed tomography, magnetic resonance imaging, and enteroscopy in particular.
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Hecke PV. Current awareness. NMR IN BIOMEDICINE 2000; 13:314-319. [PMID: 10960923 DOI: 10.1002/1099-1492(200008)13:5<314::aid-nbm627>3.0.co;2-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In order to keep subscribers up-to-date with the latest developments in their field, John Wiley & Sons are providing a current awareness service in each issue of the journal. The bibliography contains newly published material in the field of NMR in biomedicine. Each bibliography is divided into 9 sections: 1 Books, Reviews ' Symposia; 2 General; 3 Technology; 4 Brain and Nerves; 5 Neuropathology; 6 Cancer; 7 Cardiac, Vascular and Respiratory Systems; 8 Liver, Kidney and Other Organs; 9 Muscle and Orthopaedic. Within each section, articles are listed in alphabetical order with respect to author. If, in the preceding period, no publications are located relevant to any one of these headings, that section will be omitted.
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Affiliation(s)
- PV Hecke
- Katholicke Universiteit Leuven, Facultiet der Geneeskunde, Biomedische NMR Eenheid, Onderwijs en Navorsing, Gasthuisberg, B-3000 Leuven, Belgium
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