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Enterography Technique

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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.

Report

Faculty

Benjamin Spilseth, MD, MBA, FSAR

Associate Professor of Radiology, Division Director of Abdominal Radiology

University of Minnesota

Tags

Non-infectious Inflammatory

MRI

Large Bowel-Colon

Idiopathic

Gastrointestinal (GI)

Crohn’s Disease

Body

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