Interactive Transcript
0:01
So here's a nice example from an earlier case,
0:03
but this is a really great case to show what
0:05
acute inflammation is supposed to look like.
0:07
And in this case, when we look at our
0:11
T2 sequences, we immediately notice
0:14
there's a substantial amount of edema.
0:16
This bowel wall is clearly brighter
0:18
than the adjacent skeletal muscle.
0:20
It's an edematous appearance as
0:22
expected with acute inflammation.
0:24
Additionally, on the enhancement piece,
0:27
we see some findings that also indicate
0:29
that there's some acute inflammation.
0:30
First of all, we see enhancement not just of the
0:33
wall, but extending to the fat surrounding the
0:35
wall of the terminal ileum and ascending colon.
0:39
That clearly indicates there's
0:40
some degree of acute inflammation.
0:42
Additionally, I believe that several portions
0:46
of this highly inflamed bowel look ulcerated.
0:48
You kind of see divots and defects
0:51
extending into the lumen of the wall
0:53
of the bowel.
0:54
And that ulcerated appearance is highly
0:56
specific for an acute inflammatory process.
0:59
However, there could still be
1:00
a chronic fibrotic process.
1:02
So we want to also look at that.
1:04
And to do that, I think looking at our
1:07
delayed enhancement pattern is important.
1:09
And so this is our early phase, a little
1:11
bit of motion, but you can really see
1:13
that there's a lot of inflammation.
1:15
It's a lot more enhancing than the adjacent bowel.
1:18
When we look at the more delayed phase,
1:20
that degree of hyper enhancement is
1:21
if anything, dialed down a little bit.
1:24
It's not as stark.
1:25
It's clearly still hyper enhancing,
1:27
but it's not as stark as before.
1:29
So, because it didn't increase by a substantial
1:32
amount on that seven-minute images,
1:34
it wouldn't meet the criteria to say that it's
1:36
got increased seven-minute enhancement, which
1:38
would indicate a chronic process on top of it.
1:41
So there's clearly acute inflammation in this
1:42
case, and it's probably predominantly,
1:45
if not entirely, an acute inflammatory process.
1:48
And so the management for this case is not surgical.
1:50
They want to do something to improve
1:53
the immunologic milieu for this patient.
1:56
And so something like steroids or Infliximab or
1:59
some sort of type of drug is going to be what
2:03
the gastroenterologist is going to need to tame
2:05
this down and, and improve the patient's symptoms.
© 2024 MRI Online. All Rights Reserved.