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Magnetic resonance imaging evaluation of small intestinal Crohn's disease

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Imaging evaluation in patients with Crohn's disease is based on morphological abnormalities, traditionally disclosed by barium studies including conventional enteroclysis, and more recently by cross-sectional imaging. A major prerequisite for optimal image quality and a more confident diagnosis is the adequate luminal distension of the bowel, which is usually achieved by administering an intraluminal contrast agent through a nasojejunal catheter. Magnetic resonsance enteroclysis is a new technique that combines the advantages of volume challenge with state-of-the-art ultrafast pulse sequences, resulting in an excellent demonstration of the anatomy of the small bowel. Magnetic resonance enteroclysis compares favourably with conventional enteroclysis in detecting, localising and assessing the extent of involved small bowel segments. Luminal narrowing and extramural manifestations or complications of the disease can also be accurately assessed by the technique. Imaging features including the presence of deep ulcers, extensive wall thickening and mesenteric lymph nodes exhibiting marked gadolinium enhancement correlate strongly with disease activity. Although the clinical utility of magnetic resonsance enteroclysis in Crohn's disease has been widely recognised, its routine application is currently limited to academic centres. Its clinical indications may include follow-up studies of known disease, the classification of Crohn's disease subtypes, an estimation of disease activity and a determination of the extramucosal extent and spread of the disease process.

Section snippets

Contrast agents

Various contrast agents have been proposed for small bowel MRI applications.9, 10, 11, 17, 18 The most important characteristics of an intraluminal contrast agent suitable for intestinal application may be summarised as follows: uniform and homogeneous lumen opacification, a high contrast resolution between the lumen and bowel wall, a lack of significant adverse effects and low cost. In addition, minimal mucosal absorption and the absence of artefact formation are highly desirable for an

Crohn's disease

The diagnosis of Crohn's disease is established by combining clinical, imaging, endoscopic and histological features. The role of imaging has nowadays expanded to incorporate the classification of Crohn's disease subtypes. Accurate classification based on MRI findings can be achieved when using a technically demanding MRI examination protocol that can guarantee optimal luminal distension.

MRI using the oral administration of a contrast agent, referred to as magnetic resonance enterography, is

Summary

MRI currently contributes to the diagnostic assessment of small intestinal disease. Its most important advantages include superb soft tissue contrast, the ability to acquire functional information, direct multiplanar imaging and a lack of radiation exposure. Adequate bowel distension, homogeneous lumen opacification, fast sequences with breath-hold acquisition times, the use of both T1- and T2-weighted imaging and contrast enhancement are vital for optimal MRI examination. In particular, a

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