0:01

All right, so for this case, what we can see is an

0:04

area of dilated bowel on the True FISP, and you can

0:10

see that it may be questionably narrowed on both sides

0:12

of that, but this little area looks dilated, so it

0:16

looks like there's a sacculation and some narrowing.

0:18

And what we're going to try to do is decide, is this an

0:21

acute process or a chronic process that's causing this?

0:24

When we look at our cine images, you can see

0:26

the same thing, which is this doesn't move here.

0:28

There's a stricture of some sort, and there's a

0:31

sacculation and dilated bowel near that stricture.

0:35

So it's a nice use of the cine to really

0:37

confirm that that is a true stricture.

0:40

Next, we want to classify this though.

0:42

Is this an acute process or chronic process?

0:44

So there are two other key

0:45

sequences we're going to look at.

0:47

One is the enhancement pattern.

0:49

So what is this doing on the 25

0:53

second and the seven-minute images?

0:55

So here's our early phase and we can

0:57

see it is enhancing a bit.

0:59

In the early phase, there's some enhancement

1:02

here that's probably a little bit more than other

1:05

bowel, but it's not a markedly enhancing process.

1:08

We also don't see enhancement extending

1:10

beyond the wall of the bowel, which is

1:11

something that we see with acute inflammation.

1:14

And we don't see breaks in the mucosa that we

1:17

would see that would say that it's ulcerated, which is

1:20

an important marker of an acute inflammatory process.

1:24

On the seven-minute images, you can see

1:27

that if anything, it's more pronounced.

1:29

You see probably more enhancement

1:31

involving a larger portion of the wall.

1:33

And so that indicates that there's a fibrotic

1:35

process going on, which makes sense because

1:38

it doesn't seem like a large acute process.

1:40

So it looks like a fibrotic process

1:43

predominantly on the seven-minute images.

1:46

We also need to look at this

1:48

with an eye to the T2 appearance, however.

1:50

44 00:01:51,595 --> 00:01:53,755 And so, when we look at our T2 series,

1:53

we want to try to use the one with the fat

1:55

saturation and look at this segment of bowel.

1:58

And this is that same area, and you're going

2:00

to have a hard time even seeing it, and that's

2:02

because it's really quite dark on the sequence.

2:05

And so there is not a lot of

2:06

active acute inflammation going on.

2:09

On this one, there's probably just

2:10

a little bit of increased signal.

2:12

So this, there is a little bit of

2:14

acute inflammation going on here.

2:16

And so largely, this appears to be a fibrotic process.

2:22

You know, you have increased signal on the

2:23

seven-minute images, which indicates fibrosis.

2:25

You don't have ulceration.

2:27

You don't have enhancement beyond the wall.

2:30

And on the edema appearance,

2:32

you have a little bit of edema.

2:33

So there's clearly a fibrotic process, as we

2:36

saw with the seven-minute images, and there's

2:38

a small amount of acute process probably on

2:41

one of these strictures, while the other one

2:43

looks like it doesn't have much acute process.

2:46

So because this is a predominantly fibrotic process,

2:48

if this patient is symptomatic because of these strictures

2:51

and they're having bowel obstructions or other

2:52

problems, this will end up being a surgical case.

2:55

They need to be treated in conjunction with the

2:58

not just the gastroenterologist, but a bowel surgeon

3:02

is going to want to get involved because that's

3:03

going to be the only way to cure this process if the

3:07

patient is symptomatic from these findings.