Interactive Transcript
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So the first step that we're going to do is
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go through the technique for MR enterography,
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not the most exciting piece of the puzzle for
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reading Crohn's disease, which I think is a fun
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thing to do, but it is the most important piece,
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probably. If you don't get a good study, you're
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not going to do a good job as a radiologist.
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And so whether you're the one in charge of your
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protocols or someone in your practice, it's really
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important to do this well and do it the right way.
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So I'll talk a little bit about how we do it
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here at the University of Minnesota, um,
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and we'll also include with this talk,
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we'll have a nice reference to what the Crohn's
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disease focus panel of the SAR recommends for
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exact technical factors and specifications.
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Because I think making sure you follow
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those recommendations will definitely
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put you in line with what you need to
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be doing for your patients and keep you
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ahead of the curve as far as
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what the standard of practice is.
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So, at the University of Minnesota, you do want to be...
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Here's what we have, uh, we do ask the patients fast,
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we can do it two to four hours. The main thing is just
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so you don't have too much stool or food in the small
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bowel; there will be stool in the colon. We don't
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ask that patients do enemas; some protocols will do that,
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and we may get slightly better colonic disease
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evaluation, but it's not necessary for most cases.
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As you all know, it's also important that
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you drink some sort of hyperosmolar contrast.
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So Breeza is a brand name, and that's one option.
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That's what we currently use here.
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The Lumen has been around for a long time.
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That's another option used at a lot of sites.
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Drinking over 900 cc is important
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and doing it relatively fast.
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So 30 to 60 minutes is a good timeframe to shoot for.
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Lastly, we do have the patients drink a glass
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of water just before getting on the table.
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Uh, that's optional, but I think it's helpful to
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get things moving and look at things in the stomach.
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As Breeza does contain several hyperosmolar
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agents, it's good to know that they’re taking
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these sorbitol, mannitol, sucralose, all those
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things, suck water into the small bowel and
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really help with distention and visualization.
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Also, as part of our protocol, we do bowel
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antiperistalsis agents, so glucagon or some other
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antiperistalsic agent is really needed for MRI.
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There’s a lot of administration routes possible,
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and for us, we do two injections of glucagon.
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We can do it IV or sub Q, and we base
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it out during the course of the exam.
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Beyond the prep, of course, you have
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to make sure you get all the sequences.
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And I think we'll show you all the sequences
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we do separately and when we do the first case,
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but here's a list of what we do for reference.
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And I think you get a much better
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sense for the exact technical details
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if you look through the reference papers, if you're
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really trying to put a good quality protocol together.
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One note: we do these cases prone if possible,
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and I'll show you why when we get to the cases.
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That's it for the boring technical
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details. Now let's move on to cases.
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