0:01

So the first step that we're going to do is

0:03

go through the technique for MR enterography,

0:05

not the most exciting piece of the puzzle for

0:08

reading Crohn's disease, which I think is a fun

0:10

thing to do, but it is the most important piece,

0:13

probably. If you don't get a good study, you're

0:15

not going to do a good job as a radiologist.

0:17

And so whether you're the one in charge of your

0:19

protocols or someone in your practice, it's really

0:22

important to do this well and do it the right way.

0:25

So I'll talk a little bit about how we do it

0:27

here at the University of Minnesota, um,

0:29

and we'll also include with this talk,

0:31

we'll have a nice reference to what the Crohn's

0:35

disease focus panel of the SAR recommends for

0:38

exact technical factors and specifications.

0:41

Because I think making sure you follow

0:42

those recommendations will definitely

0:44

put you in line with what you need to

0:46

be doing for your patients and keep you

0:49

ahead of the curve as far as

0:50

what the standard of practice is.

0:51

So, at the University of Minnesota, you do want to be...

0:55

Here's what we have, uh, we do ask the patients fast,

0:57

we can do it two to four hours. The main thing is just

1:00

so you don't have too much stool or food in the small

1:02

bowel; there will be stool in the colon. We don't

1:06

ask that patients do enemas; some protocols will do that,

1:09

and we may get slightly better colonic disease

1:12

evaluation, but it's not necessary for most cases.

1:15

As you all know, it's also important that

1:17

you drink some sort of hyperosmolar contrast.

1:20

So Breeza is a brand name, and that's one option.

1:24

That's what we currently use here.

1:25

The Lumen has been around for a long time.

1:27

That's another option used at a lot of sites.

1:29

Drinking over 900 cc is important

1:31

and doing it relatively fast.

1:33

So 30 to 60 minutes is a good timeframe to shoot for.

1:36

Lastly, we do have the patients drink a glass

1:37

of water just before getting on the table.

1:40

Uh, that's optional, but I think it's helpful to

1:42

get things moving and look at things in the stomach.

1:45

As Breeza does contain several hyperosmolar

1:48

agents, it's good to know that they’re taking

1:50

these sorbitol, mannitol, sucralose, all those

1:53

things, suck water into the small bowel and

1:55

really help with distention and visualization.

1:57

Also, as part of our protocol, we do bowel

2:00

antiperistalsis agents, so glucagon or some other

2:03

antiperistalsic agent is really needed for MRI.

2:06

There’s a lot of administration routes possible,

2:09

and for us, we do two injections of glucagon.

2:13

We can do it IV or sub Q, and we base

2:15

it out during the course of the exam.

2:17

Beyond the prep, of course, you have

2:19

to make sure you get all the sequences.

2:21

And I think we'll show you all the sequences

2:24

we do separately and when we do the first case,

2:26

but here's a list of what we do for reference.

2:29

And I think you get a much better

2:31

sense for the exact technical details

2:32

if you look through the reference papers, if you're

2:34

really trying to put a good quality protocol together.

2:37

One note: we do these cases prone if possible,

2:40

and I'll show you why when we get to the cases.

2:43

That's it for the boring technical

2:44

details. Now let's move on to cases.