BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD Sat 31 st Aug 2013 Session 4 / Talk 1 15:25 – 15:45 ABSTRACT Magnetic Resonance (MR) Enterography has become a common examination requested at out MR practice, especially for patients with Crohn’s 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 cover a brief overview of anatomy of the bowel clinical indications and the diseases most commonly involved with small bowel imaging oral and intravenous contrast agents used the importance of patient preparation pulse sequences used by our practice limitations of imaging case studies

MRE Common examination, especially for patients with Crohn’s Disease Evaluation of intra- and extra-luminal structures Aid in diagnosis, assessment and exclusion of small bowel disease

Crohn’s Disease Idiopathic chronic inflammatory disease of the GI tract Most commonly affects the terminal ileum and ileo-caecal region Onset usually in early adulthood Another peak in 50-70s

Symptoms of Crohn’s Disease Vague abdominal pain Weight loss Diarrhoea Sinuses, ano-rectal fistula, abscesses Obstruction

Characterization of Crohn’s Ulceration of the bowel Erosion Inflammation Skip lesions

Advantages & Disadvantages High resolution High tissue-contrast Multi-planar Absence of ionizing radiation Can be combined with MR imaging of the pelvis Relies on adequate bowel preparation to provide luminal distension Cost

Patient Preparation NBM for 4 hours Drink 3 bottles of VoLumen in the hour prior to their examination IV access

MRE Technique Coronal T2 & T2 F/S SSFSE Axial T2 & T2 F/S SSFSE Axial DWI B500 Coronal FIESTA F/S Coronal FIESTA Dynamic Coronal LAVA-Flex Pre-Contrast Coronal LAVA-Flex Post-Contrast Dynamic Axial LAVA-Flex Delayed

Coronal FIESTA F/S

Coronal LAVA-Flex Pre-Contrast

Coronal LAVA-Flex Post-Contrast

Axial LAVA-Flex Delayed Post-Contrast

Case Study #1 44 year old female Longstanding Crohn’s disease Abnormal bowel habit Ileitis on colonoscopy

Case Study # 1

Post Contrast Images

Case study # 2 44 year old female Long term Crohn’s disease Total colectomy and ileostomy done 10 years ago Crampy abdominal pain

Case Study # 2

Post Contrast

Case Study # 3 33 year old male Ileocolic Crohn’s disease with perianal disease Increasing bowel symptoms with pain and diarrhoea

Case Study # 3

Case Study # 4 43 year old male Crohn’s disease involving the terminal ileum Previous perineal fistula Increasing abdominal pain and bloody PR discharge ?extent of small bowel disease ?extent of perineal fistula

Case Study # 4

Case Study #5 28 year old female Panproctocolectomy for FAP Chronic abdominal pain and distension CT without contrast showed no evidence of obstruction ?subacute obstruction

Case Study #5

Summary Assessment of complex or recurrent Crohn’s disease High resolution multi-planar imaging Intra- and extra-luminal disease

Thank you