Magnetic Resonance Imaging With Contrast Enema in Detecting the Colorectal Anastomosis Failure

Abstract

urpose. To test the usage of a contrast enema in the detection of anastomosis failure with magnetic resonance imaging (MRI) in patients who have undergone rectal resection. Material and methods. MRI with a contrast enema was performed at the A. Tsyb MRRCthe branch of the FSBI "NMRRC" of the Ministry of Health of the Russian Federation in the period from 2020 to 2022. The study prospectively included 12 patients after surgical treatment in the volume of rectal resection with the formation of colorectal/coloanal anastomosis and an uncertain result of conventional MRI, in 8 of whom, during a comprehensive clinical diagnostic examination, the presence of anastomosis failure was confirmed. MRI with a contrast enema was performed by targeted injection of a gadolinium-containing contrast agent in the volume of 20-50 ml into the anastomosis zone, after which a T1-weighted image was obtained with suppression of fat in this area in three orthogonal planes.Results. In all cases of anastomotic failure after a contrast enema, the leakage of the contrast agent beyond the intestinal wall was detected. In 4 patients with unconfirmed anastomotic failure, no leakage of the contrast agent was observed.Discussion. There is a small number of works in the literature describing the use of a contrast enema in MRI. The developed method by our team involves the targeted introduction of a small volume of contrast agent into the anastomosis zone, which avoids its traumatization and provides a more reliable contrast agent output through the defect. Testing of the usage of the contrast enema technique showed its good tolerability and the effectiveness of detection in the presence of small slitlike defects.Conclusion. The results obtained by us of using MRI with a contrast enema allow to consider it a safe clarifying method in difficult situations requiring confirmation of the anastomosis failure by directly registering the leakage of the contrast agent beyond the intestinal wall, which in the future can complement the conventional MRI examination.