Interactive Transcript
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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
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try to use the ones that we think are most critical
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for detecting any areas of small bowel disease.
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I like to start with the coronal oftentimes,
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and in the coronal, we clearly see a segment
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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.
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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
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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,
1:05
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
1:14
through here, so we're going to want to pay
1:16
attention to that on our other sequences, but
1:18
the remaining colon, I don't see too much.
1:21
So now we're going to look at our other sequences
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because we've so far detected at least two adjacent
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segments of bowel and potentially the sigmoid.
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So let's look at our other sequences
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to see if we can see the same stuff.
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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
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look super inflamed here, and it doesn't look like
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there's a lot of wall thickening at that site.
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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.
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And so as we look at that sequence, here's our disease
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terminal ileum, and here's the other disease segment.
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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.
2:10
And I don't think we picked that up as easily
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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.
2:19
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.
2:32
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.
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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
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sequences we noted that the fold patterns
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look normal without evidence of disease.
3:34
So that's the first step is detection.
3:37
The next step is to measure the lengths of all the
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disease segments to include that to help our
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gastroenterologist and then move on to other features
3:45
such as the potential for strictures or fistulas.
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