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BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD

Sat 31 st Aug 2013 Session 4 / Talk 1 15:25 – 15:45. BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD. ABSTRACT

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BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD

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  1. Sat 31stAug 2013 Session 4 / Talk 1 15:25 – 15:45 BROOKLYN 3 MRI USER GROUP Cate HOLLINSHEAD 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

  2. MR EnterographyCate Hollinshead

  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

  10. Coronal FIESTA F/S

  11. Coronal LAVA-Flex Pre-Contrast

  12. Coronal LAVA-Flex Post-Contrast

  13. Axial LAVA-Flex Delayed Post-Contrast

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

  15. Case Study # 1

  16. Case Study # 1 Post Contrast Images

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

  18. Case Study # 2

  19. Case Study # 2

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