0:01

All right, sticking with the same case that

0:02

we've talked about as having Crohn's disease

0:05

because of the asymmetric enhancement, the other

0:08

pieces we want to do is look at other things

0:11

that can be markers of severity of the degree

0:14

of inflammation, the degree of Crohn's disease.

0:16

And one of the things we need to

0:17

talk about is the wall thickness.

0:19

And so in this case, I can think you

0:21

can see the wall really well on these T2

0:24

coronal series with all fat saturation.

0:27

And when you can see it well on this series, this

0:29

is probably the best series to measure things.

0:31

Sometimes you're going to see it better on

0:34

something with less motion, such as a True FISP.

0:36

However, you often have that India

0:37

ink artifact on a True FISP sequence.

0:39

So measuring things on a True FISP

0:41

sequence can be problematic at times.

0:44

Similarly, on the post-contrast sequences,

0:47

you may have motion, such as this case,

0:49

that makes it harder to measure things.

0:51

And also you may have trouble deciding where

0:54

the wall actually ends, because inflammation

0:56

can seep into the fat surrounding the wall.

0:59

So when you have a really good quality T2 series,

1:01

like we do in this case, this is the best

1:03

series to look for the degree of wall thickening,

1:06

and I think it is important to measure this either,

1:09

you can either report the actual size of

1:11

the wall thickening, or you can classify it.

1:13

And I prefer doing some sort of classification

1:16

in the mild, moderate, and severe.

1:18

So the experts at the SAR DFP looking

1:23

at Crohn's disease have said that they

1:25

recommend calling it mild wall thickening

1:28

if you're in the 3 to 5 millimeter range.

1:30

A moderate wall thickening at five to nine millimeters.

1:33

And then if you're over 10 millimeters,

1:35

that's a severe wall thickening.

1:37

So in this case, you want to measure the degree

1:39

of wall thickening you have at this site.

1:41

And here we're at 13 millimeters at a good measurement.

1:45

And that would put it in the severe

1:48

category for wall thickening.

1:50

A couple of other things to mention is that

1:53

you want to try to find an area where you

1:54

can see the wall really well, and that

1:56

it has at least some distention.

1:58

For instance, on this axial series,

2:02

you know, it's totally undistended here.

2:03

You're not going to want to measure in an

2:05

area where there's absolutely no distention.

2:08

So getting at least some distention of the

2:10

wall, if you can get it more distended than that,

2:12

that's where you should measure it.

2:14

But this is such a severe case, I don't think

2:15

you're going to see a lot more distention than that.

2:18

But it is recommended that you try to find an area

2:21

where it's a little less distended, but still showing

2:23

the maximal degree of inflammation.

2:25

So, for instance, we could try to measure

2:26

here because it's a little more distended

2:28

and we're still pushing that, you know,

2:30

severe categorization of over a centimeter.

2:32

So I think this is pretty clearly someone

2:34

with a severe disease based on wall thickness.