0:01

In addition to that 7-minute image, I think there's

0:03

a couple of other optional sequences that are important.

0:05

One of them is diffusion.

0:07

That's becoming more standard than optional,

0:10

but I think it still probably falls into the optional

0:12

category for enterography, as opposed to most of the

0:15

abdomen where it's become more of a standard sequence.

0:17

But diffusion is important for enterography,

0:21

and so you want to do it with at least two b-values.

0:24

I think something in the 50 to

0:26

100 range and then 800 to 1000.

0:29

We typically use b-values of 50 and 1000.

0:34

And so that's our 50, and then

0:36

we separately show the 1000.

0:39

And what you'll see with these diffusion

0:43

sequences is it's very good for picking up

0:46

adenopathy, and also areas of inflammation.

0:50

It can help you really improve your sensitivity.

0:53

And you'll see, as we go through cases, why

0:55

I think diffusion really is an important

0:57

sequence that you don't want to miss.

1:00

Also, of course, you get ADC with your

1:02

diffusion, which is less helpful in bowel

1:06

just because of the small size of the wall.

1:09

And so it's really the high b-value sequence that I

1:12

spend the most time reviewing on these diffusion cases.

1:17

And then lastly, one more optional

1:19

sequence is the cine imaging.

1:21

And so we do cine imaging on all our patients.

1:23

Now, all of those other sequences that we've

1:26

discussed were done after glucagon administration,

1:29

but it's very important that if you do cine

1:31

imaging, you do it prior to glucagon administration.

1:35

And the way we do cine imaging is we just use our

1:38

steady-state precession sequence, and we do, we scan

1:42

through the abdomen at relatively thick slices, so

1:48

you can go, you know, in the 5 to 10 range, and you

1:52

go all the way through. You just want to get through

1:55

the colon; you don't have to go any further than that.

1:57

And so, several of these, the imaging

2:00

overall takes a couple of minutes.

2:02

And by doing this, you get a really good sense of

2:06

bowel wall, bowel motion, and the true dynamic

2:10

nature of the abnormalities seen with Crohn's.

2:13

And so if there are areas of stricturing or other areas

2:17

of inflammation, those areas will be less peristaltic.

2:20

And it's a nice sequence to add.

2:23

Plus, the gastroenterologists

2:25

really love this sequence.

2:26

They love when you show the pictures of strictures

2:29

and pathology on cine imaging.

2:31

It makes it look like you're

2:32

really performing at a high level.

2:34

And so, in addition to the help that it

2:36

gives me reading cases, I think it's really

2:38

helpful when showing cases to other people.