0:01

So, here's another case where I

0:02

think diffusion really helps us.

0:04

And this is a case, again, the TI is questionable.

0:08

As we look at this contrast-enhanced coronal

0:11

image in a relatively early phase, you see that

0:14

the TI looks like it may be slightly enhancing.

0:17

But when you compare it to the adjacent loops of

0:19

ileum, the degree of enhancement again all kind of seems

0:22

somewhat similar to the adjacent loops.

0:24

And so, we're left with the question of,

0:26

is that truly hyperenhancing terminal

0:28

ileum from Crohn's, or is it something else?

0:31

In this case, when we look at

0:33

our higher B-value diffusion image,

0:35

that level of restricted diffusion is

0:37

just clearly above any of the other loops.

0:40

And so, it may be that this is involved as well as some

0:43

of these other segments that have some mild inflammation.

0:45

And I think this makes us really confident that

0:47

there's some disease going on in that terminal ileum.

0:50

Another thing to notice in this case is that

0:53

there are some enlarged lymph nodes in the region.

0:55

They're not massively enlarged, but this

0:57

is just a reminder that diffusion shows

0:59

us these lymph nodes really, really well.

1:02

And so, I always look for lymph nodes on my diffusion

1:06

sequences because I think that's the one where

1:08

they just pop out at you and you're never going

1:10

to miss any significant lymphadenopathy if you

1:14

look through your diffusion sequence with care.

1:17

Another reason you need to be doing diffusion,

1:20

if you want to be performing MRI enterography at the

1:22

highest level, in addition to the sensitivity for

1:25

disease, you're going to have increased sensitivity

1:27

for lymphadenopathy, which can at times be significant.