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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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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
slide3
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
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
Symptoms of Crohn’s Disease
  • Vague abdominal pain
  • Weight loss
  • Diarrhoea
  • Sinuses, ano-rectal fistula, abscesses
  • Obstruction
characterization of crohn s
Characterization of Crohn’s
  • Ulceration of the bowel
  • Erosion
  • Inflammation
  • Skip lesions
advantages disadvantages
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
Patient Preparation
  • NBM for 4 hours
  • Drink 3 bottles of VoLumen in the hour prior to their examination
  • IV access
mre technique
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
case study 1
Case Study #1
  • 44 year old female
  • Longstanding Crohn’s disease
  • Abnormal bowel habit
  • Ileitis on colonoscopy
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Case Study # 1

Post Contrast Images

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

Post Contrast

case study 3
Case Study # 3
  • 33 year old male
  • Ileocolic Crohn’s diseasewith perianal disease
  • Increasing bowel symptoms with pain and diarrhoea
case study 4
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 5
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
summary
Summary
  • Assessment of complex or recurrent Crohn’s disease
  • High resolution multi-planar imaging
  • Intra- and extra-luminal disease