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Detecting and Characterizing Part 2

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So for this case, we're going to talk again

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about putting together a report, but this time

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for a patient with multiple segments of disease.

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And again, the first stage is detection.

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And so we're going to go through our sequences and

0:12

try to use the ones that we think are most critical

0:14

for detecting any areas of small bowel disease.

0:18

I like to start with the coronal oftentimes,

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and in the coronal, we clearly see a segment

0:25

of abnormal bowel here with some narrowing.

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It looks a little bit hyperenhancing when

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you compare it to some adjacent segments.

0:32

And also, there are some sacculations there, which

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indicate disease, probably of a chronic nature.

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We also see a similar segment here.

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So this is the true terminal ileum here.

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You can see communicating with the

0:43

ileocecal valve and the ascending colon.

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And in this disease segment, we know that there's

0:49

some creeping fat and hyperproliferation of fat, which

0:52

indicates a significant involvement of Crohn's disease.

0:56

Also, as we look for detection, we look at the

1:00

remaining small bowel, and the jejunum

1:03

folds look fairly similar to each other,

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and they all have a typical, normal-looking

1:07

pattern, so I don't see much disease there.

1:10

We look in the colon, and as I look through the

1:12

colon, I see maybe a little bit of brightness

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through here, so we're going to want to pay

1:16

attention to that on our other sequences, but

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the remaining colon, I don't see too much.

1:21

So now we're going to look at our other sequences

1:23

because we've so far detected at least two adjacent

1:27

segments of bowel and potentially the sigmoid.

1:28

So let's look at our other sequences

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to see if we can see the same stuff.

1:32

So here's that one disease of terminal ileum and

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here's another more proximal ileal disease

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segment on this T2 sequence without fat saturation.

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I'm not seeing a ton of other stuff that looks

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too concerning. That area of sigmoid colon doesn't

1:48

look super inflamed here, and it doesn't look like

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there's a lot of wall thickening at that site.

1:53

But we do want to look at our other sequences.

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I think looking at the axial sequence is going to

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help us to just see things in a different projection.

2:00

And so as we look at that sequence, here's our disease

2:03

terminal ileum, and here's the other disease segment.

2:05

And we're done.

2:06

We also see this segment over here that really

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does look like it's enhancing quite a bit.

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And I don't think we picked that up as easily

2:12

on the other sequences, but as I look here,

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it looks like there's another skipped lesion

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that we need to really closely scrutinize.

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Are there other disease segments here in

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the right abdomen, more proximal, that we

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weren't seeing with those early sequences?

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And so if we look a little more closely at that,

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we do see other areas that don't look normal.

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If you compare this bowel here to this and

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you look at it closely, you see that it does

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look like there's some type of enhancement.

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So there's more than just the two disease segments.

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There's going to be three or four disease segments.

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Lastly, we're going to look at the diffusion sequence.

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So this is a high b-value diffusion,

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and this can at times help us more

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sensitively detect the areas of disease.

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And so when we look through this, we see this area

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of disease that corresponds to the terminal ileum.

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When we see the more proximal loop here, we

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also see a little bit of increased signal at

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that site where we thought there was probably

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some inflammation in the right upper quadrant.

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But when we look in the left abdomen, we see

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loops of jejunum that all look fairly similar.

3:13

One of the things about diffusion is the

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jejunum can be a little brighter because

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the wall is thicker and segments that are

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decompressed can also be a little brighter.

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And so I think this is normal because it looks

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similar to the adjacent bowel and in our other

3:28

sequences we noted that the fold patterns

3:30

look normal without evidence of disease.

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So that's the first step is detection.

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The next step is to measure the lengths of all the

3:39

disease segments to include that to help our

3:42

gastroenterologist and then move on to other features

3:45

such as the potential for strictures or fistulas.

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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