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MR Imaging Evaluation of the Activity of Crohn's Disease

D. M. Koh1, Y. Miao2, R. J. S. Chinn1, Z. Amin1, R. Zeegen2, D. Westaby2 and J. C. Healy1

1 Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Rd., London SW10 9NH, United Kingdom.
2 Department of Gastroenterology, Chelsea and Westminster Hospital, London SW10 9NH, United Kingdom.



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  		Fig. 1A. —Bowel wall thickening and increase in mesenteric vascularity in 43-year-old man with active Crohn's disease. Barium follow-through examination shows long, narrowed segment of ileum with mucosal irregularity.

 


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  		Fig. 1B. —Bowel wall thickening and increase in mesenteric vascularity in 43-year-old man with active Crohn's disease. T1-weighted coronal MR image shows same loop of abnormally thickened small bowel (straight arrows). Note increased vascularity in adjacent small-bowel mesentery (curved arrow), analogous to CT comb sign.

 


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  		Fig. 2A. —Layered enhancement pattern in 30-year-old man with active Crohn's disease affecting terminal ileum and cecum. T1-weighted coronal MR image shows thickened cecum with low signal intensity in muscularis and submucosa (arrows).

 


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  		Fig. 2B. —Layered enhancement pattern in 30-year-old man with active Crohn's disease affecting terminal ileum and cecum. After IV administration of gadolinium, characteristic layered enhancement pattern of cecum (arrows) is seen on T1-weighted fat-suppressed axial MR image. Note also enhancement in perienteric fat.

 


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  		Fig. 3. —Fatty proliferation in 35-year-old man with rectosigmoid Crohn's disease. T1-weighted axial MR image shows fatty proliferation around thickened rectum, with widening of presacral space. Note also enlarged lymph nodes (arrowheads) in perirectal fat.

 


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  		Fig. 4. —Mesenteric lymphadenopathy in 45-year-old man with ileocecal Crohn's disease. Enlarged lymph nodes (arrow) are seen in root of small-bowel mesentery on this T1-weighted coronal MR image.

 


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  		Fig. 5. —Fistula in 40-year-old woman with pain over right iliac fossa. T1-weighted axial MR image with fat suppression obtained after administration of gadolinium shows enhancing fistulous tract (arrows) between loop of small bowel and right anterior abdominal wall.

 


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  		Fig. 6. —Abscess in 38-year-old man with acute abdominal pain. On this T1-weighted sagittal MR image with fat suppression obtained after administration of gadolinium, multiple loops of thickened bowel show layered enhancement pattern. In addition, irregular enhancing cavity (arrows) is seen, consistent with abscess, which was proven at surgery.

 


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  		Fig. 7A. —Fibrotic stricture in 40-year-old man with long history of Crohn's disease, who now presents with symptoms of gastric outlet obstruction. T1-weighted coronal MR image shows fluid-filled and dilated second part of duodenum and smooth tapering tapering of third part of duodenum (arrow).

 


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  		Fig. 7B. —Fibrotic stricture in 40-year-old man with long history of Crohn's disease, who now presents with symptoms of gastric outlet obstruction. Gadolinium-enhanced axial T1-weighted MR fat-suppressed image shows stricture (arrow) of third part of duodenum, without perceptible bowel wall thickening or enhancement.

 

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