Utility of Magnetic Resonance Imaging in Small Bowel Crohn’s Disease Diego R. Martin, Thomas Lauenstein, Shanthi V. Sitaraman  Gastroenterology  Volume 133, Issue 2, Pages 385-390 (August 2007) DOI: 10.1053/j.gastro.2007.06.036 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 Normal study showing a thick slab T2W fat-suppressed coronal (A) and thin section axial (B) image. The patient received both oral water-based contrast and an additional 800 cc of rectal water enema to produce adequate bowel distention. The thick slab image volume averages the entire small and large bowel, producing a view that is similar to a conventional small bowel follow-through or enteroclysis image. However, thin section and multiplanar capabilities on MRI facilitates detailed analysis of all the bowel loops, regardless of anatomic configuration or degree of convolution and overlap of the different bowel segments. Note the excellent and uniform fat suppression (B) allows differentiation of high signal intraluminal water contrast from the suppressed low signal adjacent fat, and visualization of thin normal dark bowel wall with no high signal edema in or around the bowel wall. Gastroenterology 2007 133, 385-390DOI: (10.1053/j.gastro.2007.06.036) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Patient with CD and nonactive/fibrotic changes of the terminal ileum. Contrast-enhanced T1W MRI shows increased enhancement of the thickened terminal ileum (TI; A, arrow). However, the bowel wall WT2 signal (B, arrow) is not significantly increased and the bowel wall margins are well defined. The TI wall thickening can be appreciated on the true free induction with steady state precession image (C, arrow), and on the contrast-enhanced T1W image where normal small bowel wall is shown for comparison (A, arrowhead). Gastroenterology 2007 133, 385-390DOI: (10.1053/j.gastro.2007.06.036) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 Patient with CD and moderately active inflammation of the TI. Contrast-enhanced T1W MRI shows increased enhancement and thickening of the TI (A, arrow) and the bowel wall WT2 signal is moderately elevated (B, arrow) owing to intramural edema. Note that the high signal on the T2W image is confined to the bowel wall and does not extend beyond the wall. Gastroenterology 2007 133, 385-390DOI: (10.1053/j.gastro.2007.06.036) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Severely active inflammation of the TI in a patient with CD. Contrast-enhanced T1W MRI shows increased enhancement of the thickened TI (A, arrow). T2 signal in and adjacent to the TI is markedly elevated (B, arrow), resulting from transmural edema and fluid tracking around the bowel wall. Gastroenterology 2007 133, 385-390DOI: (10.1053/j.gastro.2007.06.036) Copyright © 2007 AGA Institute Terms and Conditions

Figure 5 Enterocutaneous fistula (arrow) is shown on an axial true FISP MRI. This MRI technique facilitates visualization of a fistula filled with fluid, creating high signal within the lumen of the fistula track connecting the small bowel lumen to the pool of fluid collecting in the anterior abdominal wound. Gastroenterology 2007 133, 385-390DOI: (10.1053/j.gastro.2007.06.036) Copyright © 2007 AGA Institute Terms and Conditions