0:01

So in this case, we have a patient

0:02

who happens to be a cystic fibrosis patient

0:05

who’s experiencing abdominal pain in the upper abdomen,

0:08

and got an MRI enterography to evaluate that.

0:11

And this shows an interesting finding,

0:14

which is best seen in the jejunum here.

0:17

And you can see some areas of bowel

0:19

wall thickening involving that jejunum.

0:22

It’s a little bit hard to evaluate on the T2 series,

0:25

but you can certainly see that that wall is thick.

0:27

It also looks a little funny

0:28

in that it’s a little darker

0:30

than what we typically see.

0:32

And so let’s look at our post-contrast images and

0:36

it has a really odd appearance here, doesn’t it?

0:38

It’s got these dark lines and linear things

0:41

within the wall of the bowel there.

0:45

Why is that there?

0:46

It almost looks like fat.

0:47

However, if we look closely, it even

0:49

looks like it’s blooming a little bit.

0:50

And so that should be the key for us that when we

0:53

see that blooming, we need to think about air, and

0:55

air does pose both advantages and problems on MRI.

0:59

One thing is that it can cause artifacts.

1:01

If there’s a lot of it, it can make evaluation

1:03

of the bowel wall adjacent to a different.

1:06

And the other problem is if it’s in the bowel wall,

1:10

such as in the case of pneumatosis, it can be

1:12

hard to identify because it appears as black,

1:15

and it’s difficult to pick up on a lot of sequences.

1:17

So remember that typically these T1-weighted

1:20

sequences are done with a gradient recall

1:22

that go-type technology, and that does lead

1:26

to T2 star artifacts and extra blooming.

1:29

And so if you can pick up on that,

1:30

it can help you realize that there’s air.

1:33

And that’s how we diagnosed

1:34

this patient with pneumatosis.

1:36

Also, interestingly, this patient had in

1:38

and out of phase imaging done as well.

1:40

And, um, if you do have in and out of phase

1:43

imaging, which typically isn’t done with

1:45

enterographies, and I don’t think has to be

1:47

part of your sequence, but obviously it’s

1:49

done with the bulk of our abdominal exams.

1:51

So this tool can be used for any cases where

1:55

you’re looking for air on abdominal imaging.

1:57

And you see even more blooming

1:58

because this is also a GRE sequence.

2:02

And without the fat saturation, the blooming and

2:05

the air in the bowel wall becomes much more apparent.

2:09

And so if you have this sequence, it can really

2:11

help you pick up things, air in the wall of

2:13

the bowel, such as this case with pneumatosis.

2:16

If you want to see the complementary

2:19

CT, it’s much more obvious, obvious.

2:22

And I think we’ve all seen this many, many times.

2:25

Certainly, this was thought to be due to the patient’s

2:28

underlying cystic fibrosis and a benign pneumatosis,

2:31

but shows the difficulty and importance of remembering

2:34

to look for pneumatosis on your MRF enterography exams.