BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree...BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree of activity,help clinicians to identify patients in need of surgery,and can be used for patient follow-up.AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease(IBD)patients in Egypt.METHODS The study was conducted on 40 patients with IBD.All patients were subjected to clinical assessment,laboratory investigations,bowel ultrasound,MRE,and colonoscopy up to the terminal ileum with biopsies for histopathological examination.RESULTS This study was conducted on 14 patients(35%)with ulcerative colitis and 26 patients(65%)with Crohn's disease;34(85%)of these patients had active disease.Bowel ultrasound detected different bowel lesions with the following accuracies:ileum(85%),large bowel(70%),fistula(95%),stricture and proximal dilatation(95%)and abscesses(100%).Also,it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.CONCLUSION In comparison to MRE,bowel ultrasound is a useful,non-invasive,and feasible bedside imaging tool for the detection of inflammation,detection of complications,and follow-up of IBD patients when performed by the attending physician.展开更多
Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial an...Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial and is still not completely known; globally the westernization of lifestyle is causing an increasing incidence of CD, with peak age of 20-30 years. The diagnostic workup begins with the evaluation of the clinical history, physical examination and laboratory tests. However, the clinical assessment is subjected interobserver variability and, occasionally, the symptoms of acute and chronic inflammation may be indistinguishable. In this regards, the role of magnetic resonance(MR) enterography is crucial to determine the extension, the disease activity and the presence of any complications without ionizing radiations, making this method very suitable for young population affected by CD. The purpose of this review article is to illustrate the MR enterography technique and the most relevant imaging findings of CD, allowing the detection of small bowel involvement and the assessment of disease activity.展开更多
BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect diffe...BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.展开更多
Inflammatory bowel diseases(IBD) represent challenges, both from a diagnostic, and therapeutic point of view. Deep-seated anatomic structures are difficult to assess by ultrasound technique alone. As radiation-free al...Inflammatory bowel diseases(IBD) represent challenges, both from a diagnostic, and therapeutic point of view. Deep-seated anatomic structures are difficult to assess by ultrasound technique alone. As radiation-free alternative cross-sectional imaging method, magnetic resonance imaging of the intestinal structures is costly and time-consuming. Examination of pediatric patients imply additional considerations: reduction of body motions in younger children and consideration of the most appropriate preparation, and examination technique. The demanding Sellink technique is the only means for appropriately distending the lesser intestine in order to detect small bowel strictures. Oral intake of contrast medium(CM) alone shows its limitations regarding distensibility. The need for intravenous contrast media application needs to be considered, too. Active inflammation of both intestinal wall, and mesentery can be demonstrated accurately. Nevertheless, viable alternatives to CM application is desirable, considering non-negligible adverse reactions. Recent data suggest diffusion weighted imaging might fill this diagnostic gap. Irrespective of sequence technique chosen, bowel movement remains a major obstacle. Antispasmolytics in their function as smooth muscle relaxants help in improving image quality, however, their use in children might be off-label. Optimal preparation for the examination and appropriate imaging technique allow for diagnosing typical patterns of changes in IBD, such as bowel wall thickening, ulcers, mural stratification, strictures, creeping fat, and comb sign, and lymphadenopathy. The article gives a detailed overview of current significance of magnetic resonance imaging pediatric patients suffering from IBD, considering indications, limitations, and safety aspects.展开更多
AIM： TO determine if a nasojejunal tube （NJT） is required for optimal examination of enteroclysis and if patients can be examined only in the supine position. METHODS： Data were collected from all patients undergo...AIM： TO determine if a nasojejunal tube （NJT） is required for optimal examination of enteroclysis and if patients can be examined only in the supine position. METHODS： Data were collected from all patients undergoing small bowel （SB） magnetic resonance imaging （MRI） examination over a 32-mo period. Patients either underwent a magnetic resonance （MR） follow-through （MRFT） or a MR enteroclysis （MRE） in the supine position. The quality of proximal and distal SB distension as well as the presence of motion artefact and image quality were assessed by 2 radiologists. RESULTS： One hundred and fourteen MR studies were undertaken （MRFT-49, MRE-65） in 108 patients in the supine position only. Image artefact was more frequent in MRE than in MRFT （29.2% vs 18.4%）, but was not statistically significant （P = 0.30）. Adequate distension of the distal SB was obtained in 97.8% of MRFT examinations and in 95.4% of MRE examinations, respectively. Proximal SB distension was, however, less frequently optimal in MRFT than in MRE （P = 0.0036）, particularly in patients over the age of 50 years （P = 0.0099）. Image quality was good in all examinations. CONCLUSION： All patients could be successfully iraaged in the supine position. MRE and MRFT are equivalent for distal SB distension and artefact effects. Proximal SB distension is frequently less optimal in MRFT than in MRE. MRE is, therefore, the preferred MR examination method of the SB.展开更多
文摘BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree of activity,help clinicians to identify patients in need of surgery,and can be used for patient follow-up.AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease(IBD)patients in Egypt.METHODS The study was conducted on 40 patients with IBD.All patients were subjected to clinical assessment,laboratory investigations,bowel ultrasound,MRE,and colonoscopy up to the terminal ileum with biopsies for histopathological examination.RESULTS This study was conducted on 14 patients(35%)with ulcerative colitis and 26 patients(65%)with Crohn's disease;34(85%)of these patients had active disease.Bowel ultrasound detected different bowel lesions with the following accuracies:ileum(85%),large bowel(70%),fistula(95%),stricture and proximal dilatation(95%)and abscesses(100%).Also,it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.CONCLUSION In comparison to MRE,bowel ultrasound is a useful,non-invasive,and feasible bedside imaging tool for the detection of inflammation,detection of complications,and follow-up of IBD patients when performed by the attending physician.
文摘Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial and is still not completely known; globally the westernization of lifestyle is causing an increasing incidence of CD, with peak age of 20-30 years. The diagnostic workup begins with the evaluation of the clinical history, physical examination and laboratory tests. However, the clinical assessment is subjected interobserver variability and, occasionally, the symptoms of acute and chronic inflammation may be indistinguishable. In this regards, the role of magnetic resonance(MR) enterography is crucial to determine the extension, the disease activity and the presence of any complications without ionizing radiations, making this method very suitable for young population affected by CD. The purpose of this review article is to illustrate the MR enterography technique and the most relevant imaging findings of CD, allowing the detection of small bowel involvement and the assessment of disease activity.
基金Supported by Funding from the Department of Radiology,Marmara University School of Medicine
文摘AIM: To highlight magnetic resonance enterography (MRE) for diagnosis of patients with refractory iron deficiency anemia and normal endoscopy results.
基金the Development Foundation of Region Skåne,No.REGSKANE-619091the Foundation of Skåne University Hospital,No.2017-008and the Dir Albert Påhlsson’s Foundation,No.2019.
文摘BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.
文摘Inflammatory bowel diseases(IBD) represent challenges, both from a diagnostic, and therapeutic point of view. Deep-seated anatomic structures are difficult to assess by ultrasound technique alone. As radiation-free alternative cross-sectional imaging method, magnetic resonance imaging of the intestinal structures is costly and time-consuming. Examination of pediatric patients imply additional considerations: reduction of body motions in younger children and consideration of the most appropriate preparation, and examination technique. The demanding Sellink technique is the only means for appropriately distending the lesser intestine in order to detect small bowel strictures. Oral intake of contrast medium(CM) alone shows its limitations regarding distensibility. The need for intravenous contrast media application needs to be considered, too. Active inflammation of both intestinal wall, and mesentery can be demonstrated accurately. Nevertheless, viable alternatives to CM application is desirable, considering non-negligible adverse reactions. Recent data suggest diffusion weighted imaging might fill this diagnostic gap. Irrespective of sequence technique chosen, bowel movement remains a major obstacle. Antispasmolytics in their function as smooth muscle relaxants help in improving image quality, however, their use in children might be off-label. Optimal preparation for the examination and appropriate imaging technique allow for diagnosing typical patterns of changes in IBD, such as bowel wall thickening, ulcers, mural stratification, strictures, creeping fat, and comb sign, and lymphadenopathy. The article gives a detailed overview of current significance of magnetic resonance imaging pediatric patients suffering from IBD, considering indications, limitations, and safety aspects.
文摘AIM： TO determine if a nasojejunal tube （NJT） is required for optimal examination of enteroclysis and if patients can be examined only in the supine position. METHODS： Data were collected from all patients undergoing small bowel （SB） magnetic resonance imaging （MRI） examination over a 32-mo period. Patients either underwent a magnetic resonance （MR） follow-through （MRFT） or a MR enteroclysis （MRE） in the supine position. The quality of proximal and distal SB distension as well as the presence of motion artefact and image quality were assessed by 2 radiologists. RESULTS： One hundred and fourteen MR studies were undertaken （MRFT-49, MRE-65） in 108 patients in the supine position only. Image artefact was more frequent in MRE than in MRFT （29.2% vs 18.4%）, but was not statistically significant （P = 0.30）. Adequate distension of the distal SB was obtained in 97.8% of MRFT examinations and in 95.4% of MRE examinations, respectively. Proximal SB distension was, however, less frequently optimal in MRFT than in MRE （P = 0.0036）, particularly in patients over the age of 50 years （P = 0.0099）. Image quality was good in all examinations. CONCLUSION： All patients could be successfully iraaged in the supine position. MRE and MRFT are equivalent for distal SB distension and artefact effects. Proximal SB distension is frequently less optimal in MRFT than in MRE. MRE is, therefore, the preferred MR examination method of the SB.
