Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn’s Disease Disease-Focused Panel

Gandhi, Namita; Dillman, Jonathan R.; Grand, David; Huang, Chenchan; Fletcher, Joel G.; Al-Hawary, Mahmoud M.; Anupindi, Sudha A.; Baker, Mark E.; Chatterji, Manjil; Fidler, Jeff L.; Gee, Michael S.; Grajo, Joseph R.; Guglielmo, Flavius F.; Jaffe, Tracy A.; Rimola, Jordi; Taouli, Bachir; Taylor, Stuart A.; Yeh, Benjamin M.

doi:10.1007/s00261-020-02407-8

Cited by 15 publications

(19 citation statements)

References 18 publications

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“…Colonic preparation prior to MRE is currently an uncommon practice; for example, in a recently survey of 16 American academic institutions, no institution reported performing colonic preparation prior to MRE exams. 11 Furthermore, it has been suggested that bowel cleansing may not be required for MRE because small intestinal transit is not affected by a loaded colon. 12 One may further argue that MRE focuses on small bowel, and so optimization of colonic image quality is not required because the colon is not the target organ of evaluation.…”

Section: Discussionmentioning

confidence: 99%

Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics

Zhang

Chang

Wang

et al. 2021

Magnetic Resonance Imaging

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Background MR enterography (MRE) is generally performed without bowel preparation, but the frequency and extent by which bowel contents affect bowel wall visualization are poorly described in the literature. Purpose To evaluate MRE bowel wall visualization quality relative to bowel lumen contents and patient demographics. Study Type Retrospective, single‐center. Population One hundred and four consecutive patients (mean age 29 years, range 5–76 years) without prior bowel resection who had undergone MRE. Field Strength/Sequence 3 T (N = 87) or 1.5 T (N = 17)/T2‐weighted single‐shot spin echo (T2WI) and fat‐saturated T1‐weighted gradient echo (T1WI) without and with gadolinium. Assessment For the proximal and distal jejunum and ileum and colon, three readers independently categorized bowel lumen signal (water = bright T2 dark T1, T1‐bright, or air = dark T2 and T1 signal) and scored distension (0 = poor, 1 = moderate, 2 = well) and wall enhancement (0 = unclear, 1 = perceptible, 2 = clear) based upon gadolinium enhanced T1WI for the 104 MRE exams). The bowel visualization score was the sum of the wall enhancement and distension scores and was considered adequate if ≥3. Statistical Tests Wilcoxon signed‐rank test. Results The bowel lumen content was water signal in 93% (97/104 scans), 92% (95/104), 98% (102/104), and 93% (92/104) of the proximal and distal jejunum and proximal and distal ileum, respectively, but only in 12.5% (13/104) of the colon. There was adequate bowel visualization of 53.8%, 77.8%, 84.6%, 90.4% of the proximal and distal jejunum and proximal and distal ileum, respectively, but only 19.2% of the colon. In children (age < 18 years), the visualization score of the ileum was lower when the adjacent colon contained air (2.4 ± 0.97) compared to water (3.75 ± 0.29, P < 0.05) or T1‐bright material (3.21 ± 0.82, P < 0.05). Data Conclusion Without bowel preparation, colon wall visualization was often unsatisfactory at MRE, and air‐filled colon also degraded small bowel visualization, particularly in children. Level of Evidence 4 Technical Efficacy Stage 1

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Section: Discussionmentioning

confidence: 99%

Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics

Zhang

Chang

Wang

et al. 2021

Magnetic Resonance Imaging

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“…Images are typically acquired in the coronal plane, though some institutions also perform a delayed axial (up to eight minutes post-injection), which some authors have suggested improves lesion detection and disease grading (34). A recent published survey of member institutions of the Society of Abdominal Radiology Crohn's Disease Focused Panel revealed all but one institution regularly administered IV contrast for MR-enterography, routinely acquiring two to five (median four) post-contrast phases including subtraction images (15). (35)If gadolinium is contraindicated, at least one study has shown that T2-weighted sequences in conjunction with diffusion weighted images, without the use if IV contrast, was non-inferior to contrast-enhanced MRE in well-prepared patients that did not have penetrating complications of Crohn Disease (33).…”

Section: Intravenous Contrast Agentsmentioning

confidence: 99%

“…Multiple recent studies have demonstrated similar distension efficacy of a sugar alcohol flavored beverage (Breeza; Beekley Corp., Bristol, CT) when compared with low-density barium suspension although with preferred palatability and texture profile (14,25). These findings are reflected in a survey of academic radiology groups represented by members of the Society of Abdominal Radiology Crohn's Disease-Focused Panel (DFP) with over 80% of institutions using either a sugar alcohol flavored beverage or low-density barium suspension (15). Iron-based monophasic oral contrast darken the bowel lumen signal on both T1 and T2 weighted images and can improve visualization of bowel wall edema and tumors on T2 weighted images and bowel wall enhancement with intravenous contrast.…”

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confidence: 94%

State of the Art MR Enterography Technique

Chatterji

Fidler

Taylor

et al. 2021

Topics in Magnetic Resonance Imaging

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Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating bowel disease. While MRE can be used to assess a number of bowel conditions, the most common reason to perform MRE is for the diagnosis, surveillance and detection of complications of inflammatory bowel disease (IBD) (Table 1) (3-10). MRE has several significant advantages over CT enterography (CTE) and traditional barium-based fluoroscopic exams (i.e. small bowel series and enteroclysis) in evaluating IBD. MRE does not use ionizing radiation which is important for IBD patients, many of which present earlier in life and may require multiple imaging exams during their lifetime to monitor treatment (3, 4, 6-12). MRE's higher contrast resolution and multiphasic post contrast sequences compared to CTE makes MRE more sensitive in identifying bowel wall hyperemia and fibrosis and able to provide insight into the severity of small bowel inflammation (4). MRE also offers small bowel motility evaluation with "cine" sequences, a feature not available with CTE, which can help identify bowel inflammation, strictures, adhesions and small bowel masses (4,9,12,13). Finally, compared to CTE, MRE's higher contrast resolution provides better evaluation of the perianal region to identify perianal fistulas, which can occur in up to 25% of Crohn disease patients, along with possible associated abscesses (4). Table 1: Indications for MR Enterography MR Enterography IndicationsDiagnosis of IBD-evaluate disease activity, extent and distribution Follow up known IBD-evaluate disease activity and treatment response Evaluating possible IBD-related complications such as stricture, obstruction or penetrating disease (e.g. fistula, sinus tract or inflammatory mass) Small bowel masses Non-IBD enteritis (e.g. infection, vasculitis or treatment-related enteritis)

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“…3,4 However, this practice is currently not a clinical standard as evident from a recent survey of academic institutions. 5 Moreover, a recent study by Sinha et al has suggested that bowel cleansing is not necessary since MRE primarily focuses on the small bowel, which is unaffected by a loaded colon. 6 In this issue of JMRI, a research article by Zhang et al explored bowel wall visualization using MRE in relation to the bowel lumen content.…”

mentioning

confidence: 99%

“…In addition, some studies have used bowel preparation protocols, which can affect the quality of bowel visualization 3,4 . However, this practice is currently not a clinical standard as evident from a recent survey of academic institutions 5 . Moreover, a recent study by Sinha et al has suggested that bowel cleansing is not necessary since MRE primarily focuses on the small bowel, which is unaffected by a loaded colon 6 …”

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confidence: 99%

Editorial for “Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics”

Shazeeb

2021

Magnetic Resonance Imaging

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Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn’s Disease Disease-Focused Panel

Cited by 15 publications

References 18 publications

Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics

Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics

State of the Art MR Enterography Technique

Editorial for “Bowel Wall Visualization Using MR Enterography in Relationship to Bowel Lumen Contents and Patient Demographics”

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