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Active Inflammation Overview

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All right, so now that we've talked about Crohn's and

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a little bit about how we perform enterography and

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the anatomy, we get to talk about the pathology in

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Crohn's and what we typically see for these patients.

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And so here's a pretty classic, typical case

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of active Crohn's disease and what we see.

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And so when we approach these cases, I'm going

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to give you a quick overview about how I talk

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about it, and then we'll talk in depth about

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all the individual findings and how to discuss

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those findings, what's important to talk about,

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and how much detail that I go into and how much

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detailed experts recommend people put into reports.

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And so here's a case of Crohn's with

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active terminal ileal and sickle disease.

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And what you see on each sequence is different.

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So for our T2 sequence, what we

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see is that the wall is thickened.

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We see there's some edema that we want to

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verify with our fat-saturated sequences.

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To make sure it's not fat, but it does look

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brighter than the adjacent muscle.

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So we're thinking that's edema.

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And, um, we also see that there's some

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abnormal signal in the fat surrounding.

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This is a fat-saturated sequence.

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The fat saturation isn't great peripherally,

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but it's pretty good in the abdomen.

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So I think this, this works and

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you can see that is true edema.

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The true FISP isn't as critical in this case

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because we have good quality T2 images, but

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we see the same findings on our true FISP

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or steady-state precession sequence.

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On the pre-contrast, we can kind of get a sense

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that that wall is thickened, but then as we move

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to the post-contrast, it really jumps out at us

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that this, this is an abnormal segment of bowel.

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So we see a lot of inflammation extending

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up into the ascending colon down

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through the TI into that distal ileum.

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And so that hyperenhancement on the

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early phase tells us that this looks to

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be pretty active inflammatory changes.

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When we look at our axial sequences,

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we see the same, same findings.

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Again, we want to compare that to the

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adjacent bowel and see that it is clearly

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hyperenhancing inflammatory change.

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And so that's the general findings that we see that

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make up the classic hallmarks of identifying Crohn's

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disease, but once we've identified the disease, we do

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want to talk in pretty good detail about the different

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findings because each finding that we see can have

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different implications for whether it's a chronic

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disease and can have implications for how severe the

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disease is and what kind of management is needed.

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So for the next piece, we're going to talk individually

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about the different types of findings, how to talk

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about them, and what to be looking for when we do that.

Report

Faculty

Benjamin Spilseth, MD, MBA, FSAR

Associate Professor of Radiology, Division Director of Abdominal Radiology

University of Minnesota

Tags

Small Bowel

Non-infectious Inflammatory

MRI

Large Bowel-Colon

Idiopathic

Gastrointestinal (GI)

Crohn’s Disease

Body

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