Synopsis
Highlights in this session:
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Magnetic Resonance Enterography (MRE) has a pivotal role in the
management of patients with Crohn’s disease and other intestinal disorders
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Knowledge about patient preparation, scan technique and sequence
parameters optimization is of paramount importance for obtaining high quality
images
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The ability to minimize the effects of motion and other artifacts
translates into more efficient protocols and improved institutional efficiency
for the precise detection of bowel pathology
Objectives of the session:
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To review the basic MRE protocol including
bowel distension and basic MR sequences
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To introduce specific MR sequences that
are not commonly part of most MRE protocols
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To become familiar with the semiology of
inflammatory bowel disease and other bowel abnormalities such as tumors or
infectious diseases
Summary of the session:
Magnetic resonance enterography (MRE) is an imaging
procedure that uses a combination of magnetic resonance imaging (MRI) and large volumes of
enteric contrast material to better display the bowel lumen and wall. Main benefits over
other techniques for assessing bowel pathology are (a) it displays the entire thickness of the bowel wall, (b)
it allows examination of deep ileal loops without superimposition, (c)
it permits evaluation of the surrounding mesentery and perienteric fat, (d) it avoids
exposition to radiation. MRE also allows assessment of solid organs and
provides a global overview of the abdomen.
As a result, MRE is becoming the first-line modality
for the evaluation of suspected or known inflammatory bowel disease that, by
far, represents the main clinical use of this technique. Also, MRE has also
become an important alternative to traditional fluoroscopy in the assessment of
other small bowel disorders such as small bowel neoplasms.
The MRE protocol is similar across different
institutions with some variations. Knowledge of patient preparation, scan
technique and sequence parameters optimization as well as becoming familiar
with commonly encountered problems that can arise during scan acquisition is of
paramount importance for the MR technologists and interpreting radiologists. The
ability to minimize the effects of motion and other artifacts translates into
more efficient protocols and improved institutional efficiency for the precise
detection of bowel pathology.
In the setting of inflammatory bowel disease, MRE
provides relevant information for detecting and grading the presence of
inflammation, including morphological (e.g. bowel wall thickening, stricturing,
ulceration), vascular (e.g. hyper-perfusion, comb sign), edema and other
features of the disease. Also, complications such as penetrating complications
(fistulas and abscesses) or strictures are some lesions that are not rarely
unsuspected by clinicians and are relevant for the optimal management of the
disease.
Acknowledgements
Special thanks to Dr Julian Panés and Sonia Rodríguez for their continuous support.References
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