In both methods patients receive the same amount (1,5 to 2 liters) of water polyethylene glycol solution. MR Enterography patients are instructed to drink this amount in 50 minutes following a given time frame. In our Department all examinations are performed with a Siemens Magnetom Avanto 1,5T scanner.
In both examination techniques1ml of Hyoscine-N-Butilbromide(Buscopan) is given intravenously just before the iv injection of the gadolinium contrast medium. The findings in active inflammatory disease are increased enhancement and thickening of the bowel wall with layered appearance due to submucosal edema. Sometimes they are seen as small irregularities of the mucosa or as small foci of high “signal” surrounded by thickened bowel wall (Fig 2).
Longitudinal ulcers can be seen as linear high signal foci and are best depicted in HASTE images.
Mural thickening is easily seen in True FISP and T1 volumetric fat saturated contrast enhanced sequences. The degree of mural thickening correlates with presence of inflammation and the degree of activity.
This layered appearance should be distinguished from a similar layered appearance in fibrostenotic disease due to submucosal fat.
In the later case there is usually less enhancement and thickening of the bowel wall and there is no edema in the submucosa.
Increased enhancement in the delayed phase (8 minutes after contrast administration) is indicative of active disease especially when there is blurred enhancement which is seen in more severe active disease. Restricted diffusion of the bowel wall is seen in case of active disease but not in fibrostenotic disease. In addition DWI sequences sometimes can help depict inflamed bowel loops especially in cases of suboptimal distention and can also help in depiction of fistulas and small abscesses. The above described findings of active disease can be seen to subside in follow up examinations (fig 9) . Sinus tracts and fistulas are best visualized on the true FISP and thin T1 contrast enhanced images. The stellate appearance of multiple bowel loops converging to the same point “star sign” is suggestive of enteroenteric fistulas.


Phlegmon is seen as an extra intestinal mass with mild to moderate increased signal on T2 images and contrast enhancement on T1 FS images. Abscesses are seen as extraenteric fluid collections with enhancing wall on the T1 FS post-contrast images.
Some times such small collections of fluid are difficult to be distinguished from fluid filled bowel loops or pseudosacculations.
In these cases careful examination of true FISP images reveals the nature of the fluid by looking for communication with the bowel lumen.
DW images are very helpful in both identifying and differentiating abscesses as restricted diffusion is observed (figs 12 and 13).
The characteristic finding of fibrostenotic disease is fixed narrowing of the bowel with prestenotic dilatation (fig 15). This enhancement is due to fibrosis and is relatively homogenous without a stratified appearance (fig 14). Sacculations or pseudodiverticula may also be seen and are produced by asymmetric thickening and dilatation of the affected bowel segments (fig 14). Sometimes a layered appearance is seen due to submucosal fat and can be distinguished from the layered appearance in active disease as mentioned previously. Additionally the presence of submucosal fat may be recognized by the chemical shift artifact seen as a second “black line” in the inner part of the bowel wall (fig 16). In this case the affected segment shows decreased or absent peristalsis compared to normal adjacent loops.
There is no marked enhancement and no significant thickening and the findings resemble chronic disease.
2 clicks for more privacy: On the first click the button will be activated and you can then share the poster with a second click. Quantification of inflammatory activity in patients with Crohn‘s disease using diffusion weighted imaging (preliminary results). Application of DW-MRI technique and ADC values for the study of Crohn disease in large and small bowel.
Rapid bedside assessment of the renal function of patients undergoing contrast-enhanced CT. Sequential single shot coronal HASTE FS images show progressive filling of the small bowel during a 10 minute interval.


There is mural thickening of the distal ileum wall (red arrows) with a layered appearance on the T1 post-contrast image. There is thickening of the bowel wall up to 11mm (red arrows) with a stratified pattern in the post-contrast images. There is active disease with thickened bowel wall up to 14mm, increased enhancement and layered appearance. There is active disease with thickened (up to 13 mm) and avidly enhancing bowel wall with layered pattern (red arrows). An inflamed segment of the ileum is seen (green arrow) and just above this segment, a mesenteric lesion with contrast enhancement consistent with a phlegmon (yellow arrows) with foci of abscess formation (red arrows). Multiple skip lesions of bowel wall thickening (red arrows) and intervening segments of dilated small bowel with a diameter of up to 5,4 cm (yellow arrows). A dilated loop of the ileum (green arrow) is seen proximal to a stenosis due to bowel wall thickening (red arrow).
There is slightly increased enhancement in the terminal ileum with a layered appearance (red arrow).
Increased enhancement and layered appearance of the thickened wall of the terminal ileum is seen in the first image.
The wall of the bladder is thickened due to inflammation and a small abscess is seen within it (red arrow).
In this case the layered appearance is due to submucosal fat and should not be misinterpreted for active disease. The enhancement of the thickened bowel wall is mild and homogenous without layering (red arrows in the T1 FS images). There is fat signal on the in phase image and signal drop on the out of phase image (green arrows).



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