Article

Effectiveness of MR Enterography for the Assessment of Small-Bowel Diseases beyond Crohn Disease

Department of Adult Radiology, Hôpital Cochin, Paris, France.
Radiographics (Impact Factor: 2.6). 09/2012; 32(5):1423-44. DOI: 10.1148/rg.325115088
Source: PubMed

ABSTRACT

The use of cross-sectional imaging techniques for the noninvasive evaluation of small-bowel disorders is increasing. The effectiveness of magnetic resonance (MR) enterography for the evaluation of Crohn disease, in particular, is well described in the literature. In addition, MR enterography has an evolving though less well documented role to play in the evaluation of other small-bowel diseases, including various benign and malignant neoplasms arising in isolation or in polyposis syndromes such as Peutz-Jeghers, inflammatory conditions such as vasculitis and treatment-induced enteritis, infectious processes, celiac disease, diverticular disease, systemic sclerosis, and bowel duplication. MR enterography may be useful also for the evaluation of intermittent and low-grade small-bowel obstructions. Advantages of MR imaging over computed tomography (CT) for enterographic evaluations include superb contrast resolution, lack of associated exposure to ionizing radiation, ability to acquire multiplanar primary image datasets, ability to acquire sequential image series over a long acquisition time, multiphasic imaging capability, and use of intravenous contrast media with better safety profiles. MR enterography also allows dynamic evaluations of small-bowel peristalsis and distensibility of areas of luminal narrowing and intraluminal masses by repeating sequences at different intervals after administering an additional amount of the oral contrast medium. Limitations of MR enterography in comparison with CT include higher cost, less availability, more variable image quality, and lower spatial resolution. The advantages and disadvantages of MR enterography performed with ingestion of the oral contrast medium relative to MR enteroclysis performed with infusion of the oral contrast medium through a nasoenteric tube are less certain. © RSNA, 2012.

Download full-text

Full-text

Available from: Philippe Soyer, Nov 12, 2015
  • Source
    • "In current clinical practice a patient with severe abdominal pain and suspected bowel obstruction will undergo non-invasive imaging12131415. Planar X-ray, fluoroscopy, CT or MRI may be used in an attempt to detect a proximal region of distended bowel with an abrupt reduction in bowel calibre to a collapsed distal region[13]. Importantly, the radiological features determine the site of obstruction but not necessarily the cause: an adhesion may be likely but not proven. "
    [Show abstract] [Hide abstract]
    ABSTRACT: . Abdominal adhesions can cause serious morbidity and complicate subsequent operations. Their diagnosis is often one of exclusion due to a lack of a reliable, non-invasive diagnostic technique. Development and testing of a candidate technique are described below. Method . During respiration, smooth visceral sliding motion occurs between the abdominal contents and the walls of the abdominal cavity. We describe a technique involving image segmentation and registration to calculate shear as an analogue for visceral slide based on the tracking of structures throughout the respiratory cycle. The presence of an adhesion is attributed to a resistance to visceral slide resulting in a discernible reduction in shear. The abdominal movement due to respiration is captured in sagittal dynamic MR images. Results . Clinical images were selected for analysis, including a patient with a surgically confirmed adhesion. Discernible reduction in shear was observed at the location of the adhesion while a consistent, gradually changing shear was observed in the healthy volunteers. Conclusion . The technique and its validation show encouraging results for adhesion detection but a larger study is now required to confirm its potential.
    Full-text · Article · Jan 2016 · Gastroenterology Research and Practice
  • Source
    • "On MDCT-enteroclysis or enterography, jejunal leiomyoma usually presents as a well-circumscribed, submucosal, homogeneously enhancing spheroid or ovoid mass. On MR-enterography or enteroclysis, leiomyoma shows homogeneous and moderate signal intensity with marked enhancement after intravenous administration of contrast material [8]. Figure 5. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recent refinements in cross-sectional imaging have dramatically modified the investigation of the jejunum. Improvements in multidetector row computed tomography (MDCT) and magnetic resonance (MR) imaging technology have made detection and characterization of jejunal abnormalities easier. Current options include MDCT and MR imaging using either enterography or enteroclysis. The goal of this pictorial review is to outline the current imaging techniques that are used to investigate the jejunum and illustrate the most common conditions that affect this small bowel segment with a specific focus on MDCT and MR imaging using enterography or enteroclysis. MR imaging used in conjunction with optimal jejunal distension appears as the modality of choice for the diagnosis of a wide range of jejunal abnormalities. MDCT remains the first line imaging modalities because of an acute presentation in a substantial number of patients. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
    Full-text · Article · Dec 2014 · Diagnostic and interventional imaging
  • Source
    • "The good soft tissue contrast and three-dimensional imaging capabilities of MRE allow observation of the mucosa and analysis of changes of peripheral structures, which increases the information gained during the diagnostic imaging of GI diseases. MRE is more sensitive to pathological changes and is free of radiation, which makes it tremendously advantageous in the diagnosis and treatment evaluation of pediatric diseases of the small intestine (3). "
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn's disease. A total of 55 cases of small bowel Crohn's disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn's disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn's disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.
    Full-text · Article · Jul 2013 · Experimental and therapeutic medicine
Show more