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Dynamic Contrast-Enhanced MRI of the Bowel Wall for Assessment of Disease Activity in Crohn's Disease

Jasper Florie1, Martin N. J. M. Wasser2, Kasia Arts-Cieslik3, Erik M. Akkerman1, Peter D. Siersema4 and Jaap Stoker1,3

1 Department of Radiology, Academic Medical Center, G1-211, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
2 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
3 Department of Radiology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.
4 Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, The Netherlands.


Figure 1
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  		Fig. 1 —Example of enhancement curve in 44-year-old woman with moderate Crohn's disease activity shows typical enhancement pattern (ERdyn = 2.5, SoE = 2.7). Baseline intensity (SIbase = 385) increases with passing of bolus. After a short maximum intensity, a stable elevated intensity (SIend = 950) is reached. Time of start of administration of contrast agent (tinject = t0), time of start of enhancement (tstart = 36 sec), and time of maximum enhancement (tend = 90 sec) are marked. Time interval between tend and tstart is {Delta}t (90 sec - 36 sec = 54 sec). SoE = slope of enhancement, ERdyn = enhancement ratio measured on dynamic images, SIdyn,end = signal intensity at end of enhancement on dynamic images, SIdyn,base = baseline signal intensity on dynamic images.

 

Figure 2
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  		Fig. 2A —44-year-old woman with Crohn's disease and inflammation of neoterminal ileum. T1-weighted unenhanced (A) and contrast-enhanced (B) images and T2-weighted image (C) show two loops (arrows) of thickened (7 mm) bowel wall. Inflammation is clearly seen on contrast-enhanced images because bowel wall shows enhancement after IV contrast administration (ERstat [enhancement ratio measured for static images] = 2.6).

 

Figure 3
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  		Fig. 2B —44-year-old woman with Crohn's disease and inflammation of neoterminal ileum. T1-weighted unenhanced (A) and contrast-enhanced (B) images and T2-weighted image (C) show two loops (arrows) of thickened (7 mm) bowel wall. Inflammation is clearly seen on contrast-enhanced images because bowel wall shows enhancement after IV contrast administration (ERstat [enhancement ratio measured for static images] = 2.6).

 

Figure 4
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  		Fig. 2C —44-year-old woman with Crohn's disease and inflammation of neoterminal ileum. T1-weighted unenhanced (A) and contrast-enhanced (B) images and T2-weighted image (C) show two loops (arrows) of thickened (7 mm) bowel wall. Inflammation is clearly seen on contrast-enhanced images because bowel wall shows enhancement after IV contrast administration (ERstat [enhancement ratio measured for static images] = 2.6).

 

Figure 5
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  		Fig. 3A —MR images in 18-year-old girl with Crohn's disease show 8-mm thickening of terminal ileum (arrowheads). T1-weighted unenhanced image shows relatively low homogeneous signal intensity of bowel wall.

 

Figure 6
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  		Fig. 3B —MR images in 18-year-old girl with Crohn's disease show 8-mm thickening of terminal ileum (arrowheads). T1-weighted contrast-enhanced image shows enhancement of bowel wall (ERstat = 2.4) that is slightly more prominent at mucosa and submucosa.

 

Figure 7
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  		Fig. 3C —MR images in 18-year-old girl with Crohn's disease show 8-mm thickening of terminal ileum (arrowheads). In T2-weighted image, thickened wall shows primarily relatively intermediate signal intensity and relatively high signal intensity of mucosa and submucosa.

 

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