1. 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

3. 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

4. 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

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

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

7. 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

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

9. 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

11. Coronal FIESTA F/S

42. Coronal LAVA-Flex Pre-Contrast

43. Coronal LAVA-Flex Post-Contrast

44. Axial LAVA-Flex Delayed Post-Contrast

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

46. Case Study # 1

47. Post Contrast Images

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

49. Case Study # 2

51. Post Contrast

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

53. Case Study # 3

54. 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

55. Case Study # 4

57. 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

58. Case Study #5

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

60. Thank you