MRI Evaluation of Inflammatory Activity in Crohn's Disease
G. A. Javier Sempere1,
Vicente Martinez Sanjuan2,
Enrique Medina Chulia1,
Adolfo Benages3,
Alicia Tome Toyosato1,
Pilar Canelles1,
Antonio Bulto2,
Francisco Quiles1,
Iciar Puchades2,
Jaime Cuquerella1,
Julian Celma4 and
Elisa Orti1
1 Servicio Patologia Digestiva, Hospital General Universitario de Valencia,
Valencia, Spain.
2 CT and MRI Unit, Hospital General Universitario de Valencia, Avda. Tres Cruces
s/n, Valencia, Valencia, Spain, 46014.
3 Servicio de Gastroenterologia, Hospital Clinico Universitario de Valencia,
Valencia, Spain.
4 Servicio de Diagnostico por Imagen, Hospital General Universitario de
Valencia, Valencia, Spain.
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Fig. 1A. —54-year-old woman with normal ileocolonoscopic findings
(healthy control). Coronal section in true fast imaging with steady-state free
precession sequence with no evidence of colonic or terminal ileal
pathology.
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Fig. 1B. —54-year-old woman with normal ileocolonoscopic findings
(healthy control). Postcontrast T1-weighted fat-suppressed image (3D volume
interpolated breath-hold examination [VIBE]) in a healthy volunteer.
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Fig. 1C. —54-year-old woman with normal ileocolonoscopic findings
(healthy control). Terminal ileum precontrast T1-weighted fat-suppressed image
(3D VIBE) (C) and postcontrast T1-weighted fat-suppressed image (3D
VIBE) (D) show evident signal intensity increase in wall of cecum and
ileum (arrows) after contrast injection (contrast enhancement, ileum
= 104%; cecum = 101%), with normal bowel wall thickness (ileum, 3.2 mm; cecum,
2.5 mm).
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Fig. 1D. —54-year-old woman with normal ileocolonoscopic findings
(healthy control). Terminal ileum precontrast T1-weighted fat-suppressed image
(3D VIBE) (C) and postcontrast T1-weighted fat-suppressed image (3D
VIBE) (D) show evident signal intensity increase in wall of cecum and
ileum (arrows) after contrast injection (contrast enhancement, ileum
= 104%; cecum = 101%), with normal bowel wall thickness (ileum, 3.2 mm; cecum,
2.5 mm).
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Fig. 2A. —Ileal thickening in 27-year-old patient with Crohn's disease.
Barium study of small bowel shows involvement of long ileal segment (25 cm)
from ileocecal valve.
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Fig. 2B. —Ileal thickening in 27-year-old patient with Crohn's disease.
Homogeneous ileal wall thickening (fast imaging with steady-state free
precession) without extramural involvement (intact mesenteric fat).
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Fig. 2C. —Ileal thickening in 27-year-old patient with Crohn's disease.
Postcontrast fat-suppressed T1-weighted (2D fast low-angle shot) image
obtained during the active phase (Crohn's disease activity index [CDAI] = 275;
erythrocyte sedimentation rate [ESR] = 75, C-reactive protein [CRP] = 12)
shows thickening of terminal ileum (7.5 mm) and significant enhancement
(contrast enhancement = 151%) of mucosa and serosa (arrows).
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Fig. 2D. —Ileal thickening in 27-year-old patient with Crohn's disease.
Amplified portion of C shows layered enhancement pattern.
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Fig. 2E. —Ileal thickening in 27-year-old patient with Crohn's disease.
Three months after recurrence and after medical treatment (CDAI <150,
normal ESR and CRP), signal intensity and thickness of affected bowel wall
have clearly decreased (arrows) (CE = 106% and 4.1 mm,
respectively).
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Fig. 2F. —Ileal thickening in 27-year-old patient with Crohn's disease.
Amplified portion of E shows persistence of layer pattern after medical
treatment.
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Fig. 3A. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Endoscopic alterations of terminal ileum with
normal colon at endoscopy performed during initial diagnostic work-up of
disease's recurrence (Crohn's disease activity index [CDAI] = 345, erythrocyte
sedimentation rate = 120, C-reactive protein = 3.5). Coronal (B) and
axial (C) postcontrast breath-hold, fat-suppressed T1-weighted images
obtained 24 hr after endoscopy show evident wall thickening (6.9 mm) and an
important signal intensity increase after contrast injection (contrast
enhancement = 148%, arrows). Amplified image (D) shows more
detail.
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Fig. 3B. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Endoscopic alterations of terminal ileum with
normal colon at endoscopy performed during initial diagnostic work-up of
disease's recurrence (Crohn's disease activity index [CDAI] = 345, erythrocyte
sedimentation rate = 120, C-reactive protein = 3.5). Coronal (B) and
axial (C) postcontrast breath-hold, fat-suppressed T1-weighted images
obtained 24 hr after endoscopy show evident wall thickening (6.9 mm) and an
important signal intensity increase after contrast injection (contrast
enhancement = 148%, arrows). Amplified image (D) shows more
detail.
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Fig. 3C. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Endoscopic alterations of terminal ileum with
normal colon at endoscopy performed during initial diagnostic work-up of
disease's recurrence (Crohn's disease activity index [CDAI] = 345, erythrocyte
sedimentation rate = 120, C-reactive protein = 3.5). Coronal (B) and
axial (C) postcontrast breath-hold, fat-suppressed T1-weighted images
obtained 24 hr after endoscopy show evident wall thickening (6.9 mm) and an
important signal intensity increase after contrast injection (contrast
enhancement = 148%, arrows). Amplified image (D) shows more
detail.
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Fig. 3D. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Endoscopic alterations of terminal ileum with
normal colon at endoscopy performed during initial diagnostic work-up of
disease's recurrence (Crohn's disease activity index [CDAI] = 345, erythrocyte
sedimentation rate = 120, C-reactive protein = 3.5). Coronal (B) and
axial (C) postcontrast breath-hold, fat-suppressed T1-weighted images
obtained 24 hr after endoscopy show evident wall thickening (6.9 mm) and an
important signal intensity increase after contrast injection (contrast
enhancement = 148%, arrows). Amplified image (D) shows more
detail.
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Fig. 3E. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Forty days after the previous images and after
medical treatment (normalization of acute phase reactants and CDAI), decrease
in affected bowel wall thickness and signal intensity (3.7 mm and CE = 113.5%,
respectively) are present (arrows). Amplified image (F) shows
more detail.
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Fig. 3F. —26-year-old man with pain in right iliac fossa, fever, and
diarrhea for previous 2 months. Forty days after the previous images and after
medical treatment (normalization of acute phase reactants and CDAI), decrease
in affected bowel wall thickness and signal intensity (3.7 mm and CE = 113.5%,
respectively) are present (arrows). Amplified image (F) shows
more detail.
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Fig. 4. —22-year-old woman with Crohn's disease. Axial
gadolinium-enhanced fast multiplanar spoiled gradient-recalled echo image with
fat suppression and oral and rectal water administration shows increased
signal intensity and pathologic mural thickness (7.8 mm) in terminal ileon
(arrow).
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Copyright © 2005 by the American Roentgen Ray Society.
