0:01

So sticking with the same case, another

0:03

thing that we want to be looking at when

0:04

we talk about MRI is the actual signal

0:07

characteristics of the areas of inflamed wall.

0:10

And one of the real advantages of MR is that

0:12

we can actually identify bowel wall edema.

0:16

And on this series, it looks like it may be

0:19

a little bit brighter than the skeletal muscle.

0:22

And so we're thinking this wall, in addition to being

0:25

thickened and enhancing, there may have some wall edema.

0:28

It's important to say that there's wall edema

0:30

that's present because that's clearly been

0:31

shown to be a marker of active inflammation

0:34

and more severe inflammation. And so,

0:37

in order to identify that,

0:39

we don't want to just look at this T2 sequence

0:41

of fat saturation, but we also want to compare

0:43

it to our one without fat saturation. We want

0:45

to compare that to our fat-saturated sequences.

0:48

And so, you can see it can be hard to find the

0:50

wall on the fat-saturated sequences at times.

0:53

But we can see that this is the same

0:55

segment of bowel here as we were seeing

0:57

on the non-fat-saturated sequence.

0:59

And while it doesn't look that different than the

1:01

surrounding areas, if we compare this segment of

1:04

bowel to the abdominal wall over here, you can clearly

1:08

see that it's brighter than the abdominal wall.

1:10

So when you're evaluating for edema,

1:13

the recommendation is to compare it to skeletal muscle.

1:16

And if it's brighter than that, then you can say that

1:20

there's edema in the involved segments of bowel.

1:23

And I think that's clearly the case here.

1:25

But another thing to remember when you're

1:27

considering edema is don't forget that your

1:30

low b-value diffusion sequence can also

1:32

be a good way to look for bowel wall edema.

1:36

And in this case, we see probably even more

1:39

clearly on our low b-value diffusion sequences

1:42

that many of these segments of bowel are much

1:44

brighter than the adjacent skeletal muscle here

1:48

as we compare to this paraspinal musculature.

1:50

And so this clearly indicates bowel wall edema,

1:54

and I think our diffusion makes it, in this case,

1:58

much more obvious that that's what's going on.

2:01

So be sure to include that when you're

2:03

describing segments of bowel inflammation.