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MRI of Complicated Pouchitis

Rohini N. Nadgir1, Jorge A. Soto1, Klea Dendrinos2, Brian C. Lucey1, James M. Becker3 and Francis A. Farraye2

1 Department of Radiology, Boston University Medical Center, 88 E Newton St., 2nd Floor, Boston, MA 02118.
2 Department of Gastroenterology, Boston University Medical Center, Boston, MA 02118.
3 Department of Surgery, Boston University Medical Center, Boston, MA 02118.


Figure 1
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  		Fig. 1 —59-year-old man with pouch. T2 coronal image shows abnormal thickening of pouch wall.

 

Figure 2
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  		Fig. 2 —36-year-old woman with pouch. Gadolinium-enhanced T1 SPIR (spectral inversion recovery) axial image shows marked abnormal enhancement of pouch wall (arrow).

 

Figure 3
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  		Fig. 3 —47-year-old man with pouch. Endoscopic image shows erythematous, friable, ulcerated pouch mucosa.

 

Figure 4
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  		Fig. 4A —42-year-old woman with pouch and pelvic pain. Gadolinium-enhanced T1 SPIR (spectral inversion recovery) axial image shows large, multiloculated collection (arrow) posterior to pouch.

 

Figure 5
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  		Fig. 4B —42-year-old woman with pouch and pelvic pain. T2 sagittal image shows same large collection (arrow) posterior to pouch (arrowhead). Pouch wall itself was normal radiographically and endoscopically.

 

Figure 6
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  		Fig. 5 —36-year-old woman with pouch. Gadolinium-enhanced T1 SPIR (spectral inversion recovery) axial image shows marked peripheral rim enhancement around perineal fluid collection.

 

Figure 7
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  		Fig. 6A —Sinus and fistula tracts in two patients. 30-year-old man with pouch. T1 axial image shows dark, curvilinear sinus tract (arrow) between pouch (white arrowhead) and peripouch fluid collection (black arrowhead).

 

Figure 8
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  		Fig. 7B —Sinus and fistula tracts in two patients. 47-year-old man with pouch. Gadolinium-enhanced T1 SPIR (spectral inversion recovery) axial image shows marked enhancement of right perineal fistula (arrowhead), which extended to skin surface.

 

Figure 9
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  		Fig. 8 —36-year-old woman with pouch. T2 axial image shows multiple peripouch lymph nodes (white arrow) adjacent to small fluid collection (arrowhead) posterior to abnormally thickened pouch (black arrow).

 

Figure 10
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  		Fig. 9 —30-year-old man with pouch. T1 axial image shows marked peripouch fat stranding (arrow) near abnormally thickened pouch (arrowhead).

 

Figure 11
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  		Fig. 10 —59-year-old man with pouch. T2 axial image shows extensive fatty proliferation around abnormal, thickened pouch wall.

 

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