MR Imaging of the Small Bowel

Masselli, Gabriele; Gualdi, Gianfranco

doi:10.1148/radiol.12111658

Cited by 169 publications

(125 citation statements)

References 112 publications

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“…As a result, MRE is now becoming the method of choice for assessment of small bowel for inflammatory disease. 3,9 Importantly, MRE provides a diagnostic accuracy that is comparable to CT, colonoscopy and surgical pathology. [10][11][12][13] Adequate bowel distension of the small bowel is essential for this diagnostic accuracy and hence the use of OCAs.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and easy availability, (v) have easy storage and (vi) have no serious adverse side effects. 3 Currently, VoLumen® (E-Z-EM Inc., Westbury, NY), a biphasic OCA comprising 0.1% w/v ultra-low-dose barium with sorbitol, simethicone and natural gums, is commonly used for MRE examinations in the USA. However, VoLumen is not easily available for sale in Canada, the UK and Europe.…”

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confidence: 99%

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Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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Objective: To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE). Methods: This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n 5 20; psyllium, n 5 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg 21 psyllium prior to imaging.Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student's t-test and Mann-Whitney U-test.Results: Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p 5 0.338-0.908) and quantitative assessments (p 5 0.083-0.856). The mean bowel distension achieved was 20.1 6 2.2 mm for sorbitol and 19.8 6 2.5 mm for psyllium (p 5 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups. Conclusion: Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies. Advances in knowledge: This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.MR enterography (MRE) is an imaging technique used to evaluate the small bowel for diagnoses that include inflammatory bowel disease and neoplasms. Sufficiently distending the small bowel with an oral contrast agent (OCA) is critical, as collapsed loops may hide or mimic abnormalities.The OCAs employed in MRE can be classified as positive, negative or biphasic contrast agents according to their signal properties on T 1 and T 2 weighted imaging. Biphasic contrast agents typically provide low signal intensity on T 1 weighted imaging and high signal intensity on T 2 weighted imaging (T2W), and are most commonly used today because of their favourable signal characteristics for detecting bowel pathology. Water is a biphasic contrast agent, but its rapid physiological absorption from the small bowel necessitates the use of additives. These additives are often highly osmolar agents or non-osmotic agents that form hydrogels that trap water molecules in the bowel lumen. Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum. 1,2Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and eas...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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“…They radiologically classified CD into four groups: Active inflammatory, fibrostenotic, fistulizing/perforating, and reparative or regenerative subtype that could be differentiate by MR imaging due to its accuracy for the detection of morphologic and functional abnormalities, early CDs changes and help the clinicial plan appropriate therapy. The visualization of early changes due to CD, such as ulcerations and subtle wall thickening, can depict by high-resolution (thin-section) true FISP and half-Fourier RARE images ( Figure 1) [48,49] . Bowel wall thickening is the common finding of CD with sensitivity of 83%-91% and a specificity of 86%-100% at MR enterography [50] .…”

Section: Indicationsmentioning

confidence: 99%

“…Chronic fibrotic strictures have low intensity signal on T1 and T2 sequences with inhomogeneous contrast enhancement (lack of mural inflammation) edema and surrounding mesenteric hyperemia [59,60] and in many patients are likely due to a combination of active and chronic inflammation and fibrosis [61] ( Figure 6) and on MR cine imaging, it appears as a peristaltic bowel segments with mural thickening and luminal narrowing [48,62] . As pediatric CD, uncommonly manifests initially as a strictures [63] , the cumulative incidence of strictures increases with time, from 5.5% at 1-year following diagnosis to 20.5% at 10 years [64] .…”

Section: Indicationsmentioning

confidence: 99%

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Masselli

Mastroiacovo

Marco

et al. 2016

WJR

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Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

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“…The aim of diagnostic imaging of NENs in the small intestine is: -to present the primary focus; -to determine the local tumour size and presence of metastases; -to evaluate the response to treatment [32][33][34].…”

Section: Imaging Diagnosticsmentioning

confidence: 99%

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

Bolanowski

Bednarczuk²,

Bobek-Billewicz³

et al. 2014

Endokrynologia Polska

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We present revised Polish guidelines regarding the management of patients harbouring neuroendocrine neoplasms (NENs) of the small intestine and appendix. The small intestine, especially the ileum, is the most common origin of these neoplasms. Most of them are well differentiated with slow growth. Rarely, they are less differentiated, growing fast with a poor prognosis. Since symptoms can be atypical, the diagnosis is often accidental. Typical symptoms of carcinoid syndrome occur in less than 10% of patients. The most useful laboratory marker is chromogranin A; 5-hydroxyindoleacetic acid is helpful in the monitoring of carcinoid syndrome. Ultrasound, computed tomography, magnetic resonance imaging, colonoscopy, video capsule endoscopy, balloon enteroscopy and somatostatin receptors scintigraphy are used in the visualisation. A histological report is crucial for the proper diagnostics and therapy of NENs, and it has been extensively described. The treatment of choice is surgery, either radical or palliative. Somatostatin analogues are crucial in the pharmacological treatment of the hormonally active and non-active small intestine NENs and NENs of the appendix. Radioisotope therapy is possible in patients with a good expression of somatostatin receptors. Chemotherapy is not effective in general. Everolimus therapy can be applied in patients with generalised NENs of the small intestine in progression and where there has been a failure or an inability to use other treatment options. Finally, we make recommendations regarding the monitoring of patients with NENs of the small intestine and appendix. (6) w mniej niż 10% przypadków. W diagnostyce laboratoryjnej najbardziej przydatne jest oznaczenie stężenia chromograniny A, badanie stężenia kwasu 5-hydroksyindolooctowego jest pomocne w monitorowaniu zespołu rakowiaka. W obrazowaniu stosuje się ultrasonografię, tomografię komputerową, rezonans magnetyczny, kolonoskopię, wideoendoskopię kapsułkową, enteroskopię dwubalonową, scyntygrafię receptorów somatostatynowych. Szczegółowe badanie histologiczne jest kluczowym dla właściwego rozpoznania i leczenia chorych z NEN jelita cienkiego i wyrostka robaczkowego. Leczeniem z wyboru jest postępowanie chirurgiczne, radykalne lub paliatywne. W leczeniu farmakologicznym czynnych i nieczynnych hormonalnie NEN jelita cienkiego i wyrostka robaczkowego podstawowe znaczenie mają analogi somatostatyny. Terapia radioizotopowa u chorych z dobrą ekspresją receptorów somatostatynowych stanowi kolejną opcję terapeutyczną. Chemioterapia jest na ogół nieskuteczna. U pacjentów z rozsianym NEN jelita cienkiego i progresją choroby oraz nieskutecznością innych metod terapii można zastosować ewerolimus. Przedstawiono także zalecenia odnośnie monitorowania chorych z NEN jelita cienkiego i wyrostka robaczkowego. (Endokrynol Pol 2013; 64 (6): 444-493)

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MR Imaging of the Small Bowel

Cited by 169 publications

References 112 publications

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Nowotwory neuroendokrynne jelita cienkiego i wyrostka robaczkowego — zasady postępowania (rekomendowane przez Polską Sieć Guzów Neuroendokrynnych)

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