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Acute Inflammation

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So here's a nice example from an earlier case,

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but this is a really great case to show what

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acute inflammation is supposed to look like.

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And in this case, when we look at our

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T2 sequences, we immediately notice

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there's a substantial amount of edema.

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This bowel wall is clearly brighter

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than the adjacent skeletal muscle.

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It's an edematous appearance as

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expected with acute inflammation.

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Additionally, on the enhancement piece,

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we see some findings that also indicate

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that there's some acute inflammation.

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First of all, we see enhancement not just of the

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wall, but extending to the fat surrounding the

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wall of the terminal ileum and ascending colon.

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That clearly indicates there's

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some degree of acute inflammation.

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Additionally, I believe that several portions

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of this highly inflamed bowel look ulcerated.

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You kind of see divots and defects

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extending into the lumen of the wall

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of the bowel.

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And that ulcerated appearance is highly

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specific for an acute inflammatory process.

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However, there could still be

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a chronic fibrotic process.

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So we want to also look at that.

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And to do that, I think looking at our

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delayed enhancement pattern is important.

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And so this is our early phase, a little

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bit of motion, but you can really see

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that there's a lot of inflammation.

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It's a lot more enhancing than the adjacent bowel.

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When we look at the more delayed phase,

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that degree of hyper enhancement is

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if anything, dialed down a little bit.

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It's not as stark.

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It's clearly still hyper enhancing,

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but it's not as stark as before.

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So, because it didn't increase by a substantial

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amount on that seven-minute images,

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it wouldn't meet the criteria to say that it's

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got increased seven-minute enhancement, which

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would indicate a chronic process on top of it.

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So there's clearly acute inflammation in this

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case, and it's probably predominantly,

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if not entirely, an acute inflammatory process.

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And so the management for this case is not surgical.

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They want to do something to improve

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the immunologic milieu for this patient.

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And so something like steroids or Infliximab or

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some sort of type of drug is going to be what

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the gastroenterologist is going to need to tame

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this down and, and improve the patient's symptoms.

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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