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MR Enteroclysis of Inflammatory Small-Bowel Diseases

Bart M. Wiarda1, Ernst J. Kuipers2, Martin A. Heitbrink1, Arnoud van Oijen3 and Jaap Stoker4

1 Department of Radiology, Medical Center Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands.
2 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
3 Department of Gastroenterology, Medical Center Alkmaar, Alkmaar, The Netherlands.
4 Department of Radiology, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands.


Figure 1
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  		Fig. 1A —63-year-old woman with suspected Crohn's disease. Coronal thick-slab HASTE fat-saturation image shows adequate distention of jejunal loops (arrowheads) but collapsed or stenotic terminal ileum (arrow).

 

Figure 2
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  		Fig. 1B —63-year-old woman with suspected Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) fat-saturation image obtained at same time as A shows wall thickening of terminal ileum (arrows) with collapsed or stenotic lumen. Note normal folds without wall thickening of jejunal loops (arrowheads).

 

Figure 3
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  		Fig. 1C —63-year-old woman with suspected Crohn's disease. Coronal thick-slab HASTE fat-saturation image obtained a few minutes later than A shows distention of terminal ileum (arrows).

 

Figure 4
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  		Fig. 1D —63-year-old woman with suspected Crohn's disease. Coronal true FISP fat saturation image obtained at same time as C shows distended terminal ileum with wall thickening without stenosis (arrow). Thick-slab HASTE imaging facilitates optimal timing of true FISP fat-saturation sequences with maximal distention. This increases certainty of grading small-bowel stenosis.

 

Figure 5
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  		Fig. 2 —35-year-old woman with healthy-appearing small-bowel. During optimal distention, coronal true fast imaging with steady-state precession fat-saturation image shows normal folds in jejunum (arrowheads) and no stenosis or bowel wall thickening in terminal ileum (arrows).

 

Figure 6
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  		Fig. 3A —31-year-old man with known Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows almost no distention of jejunum (arrowheads) and suggesting a wide-open terminal ileum (arrows).

 

Figure 7
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  		Fig. 3B —31-year-old man with known Crohn's disease. Coronal true FISP image obtained with fat saturation during optimal distention shows normal jejunal loops (arrowheads) and short segment of bowel wall thickening of terminal ileum with high-grade stenosis (arrows). Optimal distention contributes to differentiation between stenosis and collapsed bowel loops.

 

Figure 8
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  		Fig. 4A —38-year-old woman with suspected Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation without optimal distention of small-bowel loops shows wall thickening of ileum (arrows), with increased mesenteric vascularization (comb sign, arrowheads) and creeping fat (dot).

 

Figure 9
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  		Fig. 4B —38-year-old woman with suspected Crohn's disease. Coronal true FISP fat-saturation image obtained during optimal distention shows that thickened ileum loop has intermediate- to high-grade stenosis (arrows). In accordance with A, comb sign (arrowheads) and creeping fat (dot) are visualized.

 

Figure 10
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  		Fig. 5A —21-year-old man with proven Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows two segments of bowel wall thickening, mucosal ulcerations (arrowhead), and stenosis with prestenotic dilatation (thick solid arrow) of ileum. This figure also shows fibrofatty proliferation (creeping fat, dot), mesenteric lymph nodes (thin arrow), and increased mesenteric vascularity (comb sign, open arrow). Distal from diseased proximal segment is second segment of thickened ileum loop (asterisk): skip lesion.

 

Figure 11
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  		Fig. 5B —21-year-old man with proven Crohn's disease. Coronal fast low-angle shot (FLASH) 2D fat-saturation image obtained after contrast injection shows increased contrast enhancement of two thickened segments of small-bowel loops (skip lesions, arrows) and increased mesenteric vascularity (comb sign, open arrow).

 

Figure 12
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  		Fig. 5C —21-year-old man with proven Crohn's disease. Endoscopy shows ulcerations (arrows) and loss of ileal folds.

 

Figure 13
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  		Fig. 6A —42-year-old man with known Crohn's disease. Axial true fast imaging with steady-state precession (FISP) and fat saturation shows diffuse thickening, edema (arrow), and irregular mucosa of mainly mucosa of bowel wall of ileum. Small amount of ascites (asterisk) was found in this region.

 

Figure 14
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  		Fig. 6B —42-year-old man with known Crohn's disease. Axial enhanced fast low-angle shot (FLASH) 2D fat-saturation image shows diffuse thickening, irregular mucosa (arrowhead), and intense contrast enhancement of mainly mucosa of bowel wall of ileum (arrow). This implies active disease. Active disease is also visible in sigmoid and rectum (open arrows).

 

Figure 15
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  		Fig. 6C —42-year-old man with known Crohn's disease. Endoscopy of terminal ileum shows ulcu (arrow) with wall of edema (arrowhead).

 

Figure 16
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  		Fig. 7 —46-year-old woman with midgut malrotation type 1 and suspected Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows thickening of terminal ileum (arrow), without increased contrast enhancement (not shown). Wall thickness of cecum (arrowhead) is normal. Absence of ulcerations, bowel wall edema, and increased contrast enhancement are features of inactive Crohn's disease.

 

Figure 17
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  		Fig. 8 —60-year-old man with proven Crohn's disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows fat accumulation in submucosa (arrowhead), which implies subacute or chronic disease stage. Fistula between two ileum loops (arrow) is also visualized.

 

Figure 18
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  		Fig. 9 —45-year-old woman with proven Crohn's disease. Axial true fast imaging with steady-state precession (FISP) and fat saturation shows fistula between small bowel and soft-tissue layers of abdominal wall (arrow).

 

Figure 19
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  		Fig. 10 —37-year-old woman with known Crohn's disease. Axial fast low-angle shot (FLASH) 2D fat-saturation image obtained after contrast injection shows thickened ileum loop with intense contrast enhancement (arrow). On left side of this loop is small abscess (arrowhead).

 

Figure 20
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  		Fig. 11 —75-year-old woman with recently proven celiac disease. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows decrease in jejunal folds (arrowheads) and increase in ileal folds ("ileal jejunization," arrows), which are characteristic features of celiac disease.

 

Figure 21
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  		Fig. 12 —31-year-old woman with abdominal pain and diarrhea. Axial true fast imaging with steady-state precession (FISP) and fat saturation shows diffuse thickened jejunum loop (arrow) with edema of all wall layers, especially serosa. Without proven cause, her complaints resolved spontaneously. In follow-up, no relapse of complaints is established. This case is example of jejunitis without proven cause.

 

Figure 22
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  		Fig. 13 —65-year-old man with left flank pain and infectious jejunitis. Axial true fast imaging with steady-state precession (FISP) and fat saturation shows thickened jejunal folds (arrows). Normal folds in distal jejunum (arrowhead) are shown. Parapelvic cyst can be seen in right kidney. Stool of this patient was giardiasis-positive.

 

Figure 23
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  		Fig. 14A —66-year-old woman with proven eosinophilic gastroenteropathy. Coronal true fast imaging with steady-state precession (FISP) shows diffuse loss of mucosal folds and diffuse thickened wall of all small-bowel loops (arrows). Lack of motility on thick-slab HASTE sequence with fat saturation (not shown) is also characteristic of this disease.

 

Figure 24
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  		Fig. 14B —66-year-old woman with proven eosinophilic gastroenteropathy. Endoscopy shows loss of ileum folds with nodularity (arrows) of mucosa.

 

Figure 25
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  		Fig. 15A —44-year-old woman with peritoneal dialysis and sclerosing encapsulating peritonitis. Coronal true fast imaging with steady-state precession (FISP) and fat saturation shows diffuse pronounced small-bowel wall thickening (arrows) and central localization. Thick-slab HASTE fat-saturation images reveal lack of motility (not shown).

 

Figure 26
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  		Fig. 15B —44-year-old woman with peritoneal dialysis and sclerosing encapsulating peritonitis. Coronal fast low-angle shot (FLASH) 2D fat-saturation image obtained after contrast injection shows increased diffuse enhancement of small-bowel wall (arrows).

 

Figure 27
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  		Fig. 15C —44-year-old woman with peritoneal dialysis and sclerosing encapsulating peritonitis. C, Axial CT after contrast injection shows diffuse peritoneal calcifications (arrows).

 

Figure 28
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  		Fig. 16A —75-year-old woman with radiation enteritis, 20 years after abdominal hysterectomy and radiation therapy for endometrial carcinoma. Axial true fast imaging with steady-state precession (FISP) and fat saturation shows diffuse mild thickened distended ileum loops (arrows), without peristalsis (not shown). Note colostomy bag ventral of right abdominal wall after resection of colon carcinoma 2 years ago.

 

Figure 29
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  		Fig. 16B —75-year-old woman with radiation enteritis, 20 years after abdominal hysterectomy and radiation therapy for endometrial carcinoma. Coronal fast low-angle shot (FLASH) 2D image shows increased contrast enhancement of thickened ileum loops (arrows) in contrast with normal enhancement of colon (arrowhead).

 

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