MR Imaging in Patients with Crohn Disease: Value of T2- versus T1-weighted Gadolinium-enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent

Maccioni, Francesca; Bruni, Antonio; Viscido, Angelo; Colaiacomo, Maria Chiara; Cocco, Andrea; Montesani, C; Caprilli, R.; Marini, Mario

doi:10.1148/radiol.2381040244

Cited by 250 publications

(149 citation statements)

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“…This has been shown in the application of SPAIR SSFSE for detection of active inflammation related to Crohn's disease of the small bowel (12). The use of MRI for evaluation of Crohn's disease (4,5) and appendicitis is compelling considering that most patients are young and have a greater concern for ionizing radiation-induced malignancies from CT (13)(14)(15)(16). Other intraabdominal inflammatory processes shown to be delineated by T2W FS imaging includes diverticulitis (1,17) pancreatitis (18,19), pyelonephritis (20), cholecystitis (21), and for evaluation of the acute abdomen (8,19,22).…”

Section: Discussionmentioning

confidence: 99%

“…Fat produces high signal intensity on routine SSFSE that may obscure pathological causes of high signal extending from structures surrounded by fat, such as bowel, pancreas, and kidneys. Disease processes include inflammation, infection, and abnormal fluid collections (1)(2)(3)(4)(5)(6). T2W FS images may have particular value in pregnant patients presenting with an acute abdomen (7,8).…”

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confidence: 99%

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Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Lauenstein

Sharma

Hughes

et al. 2008

Magnetic Resonance Imaging

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Purpose: To test the theoretical benefits of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) technique in clinical abdominal MRI by comparison to conventional inversion-recovery (IR) FS combined with T2-weighted (T2W) partial Fourier single shot fast spin echo (SSFSE).Materials and Methods: 1.5T MRI studies of the abdomen were performed in 28 patients with liver lesions (hemangiomas n ϭ 14; metastases n ϭ 14). T2W sequences were acquired using IR and SPAIR SSFSE. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects.Results: SPAIR-SSFSE images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR SSFSE was 20.5 Ϯ 10.2 (Ϯ1 SD) and 12.7 Ϯ 6.2, compared to 43.2 Ϯ 24.1 (P ϭ 0.000006) and 29.3 Ϯ 16.8 (P ϭ 0.0000005) for IR-SSFSE. SPAIR-SSFSE images produced higher CNR for both hemangiomas CNR ϭ 164 Ϯ 88 vs. 126 Ϯ 83 (P ϭ 0.00005) and metastases CNR ϭ 75 Ϯ 27 vs. 53 Ϯ 19 (P ϭ 0.007). Bowel wall visualization was significantly improved using SPAIR-SSFSE (P ϭ 0.002). Conclusion:The theoretical benefits of SPAIR over conventional IR FS translate into significant multiple improvements that can be measured on clinical abdominal MRI scans.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Lauenstein

Sharma

Hughes

et al. 2008

Magnetic Resonance Imaging

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“…Pariente et al [57] reviewed data from several studies that assessed the performance of MRE against ileoscopy or capsule endoscopy findings [58][59][60] and reported an overall sensitivity and specificity of 88 and 95 %, respectively. Similar figures emerged regarding the ability of MRE to identify fistulas (sensitivity 88 %, specificity 93 %) [57].…”

Section: Magnetic Resonancementioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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“…T1-weighted images also benefit from the use of fat saturation. The gadolinium-enhanced fat-suppressed spoiled gradientecho sequence provides T1-weighted images with excellent visualization of the enhanced bowel wall, which contrasts well with the low-signal-intensity mesenteric fat and negative intraluminal contrast material [34,35] .The latest technical development to speed up the acquisition process is parallel imaging, based on simultaneous acquisition of spatial har monics, or sensitivity encoding techniques. Marked improvement in spatial resolution can be achieved in shorter acquisition times [36] .…”

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confidence: 99%

“…Consequently, this technique is reliably applicable to the follow-up of patients with CD. MRI is able to detect significant variations in bowel wall thickness and contrast enhancement (CE), reflecting favorable clinical response to medical treatment of CD's relapse [30,34,49] . …”

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confidence: 99%

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

Zhu¹,

Xu²,

Gong³

et al. 2008

WJG

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High soft tissue contrast resolution, acquisition of multi-planar images and the possibility to obtain functional information make magnetic resonance an interesting imaging technique to evaluate the small bowel disease. The absence of ionizing radiation is an important feature of magnetic resonance imaging (MRI) examinations because inflammatory diseases such as Crohn's disease (CD) are studied most frequently, which are prevalent among children and young adults. MRI, using modern equipment and a rigorous technical approach, can offer detailed morphologic information and functional data on the small bowel. This article discusses the MRI protocols for small bowel and the MR imaging findings of small bowel diseases, such as CD and small bowel neoplasms. There are two main approaches for MRI of the small bowel: (1) study following oral administration of contrast material; and (2) study with distension of lumen obtained with contrast material that is introduced through a naso-jejunal tube (MR enteroclysis). Oral contrast agents for small bowel MRIOral contrast agents can be classified into positive, negative and biphasic categories according to their action on the signal intensity of bowel lumen.A positive agent is a paramagnetic substance that produces a high signal intensity on T1-weighted sequences. It reduces T1 relaxation time without, or only minimally, influencing T2 relaxation time. Because of the water content of the contrast solution, it also results in high signal intensity on T2-weighted images. Positive contrast agents include paramagnetic substances, such as gadolinium chelates, ferrous and manganic ions and manganese ions [12][13][14][15][16] . The use of positive oral contrast agents has been abandoned almost completely because a hyperintense lumen does not enable a clear differentiation with inflammatory parietal enhancement.A negative agent is a substance that produces a low signal intensity on T1-and T2-weighted sequences. These substances induce local inhomogeneity in the magnetic field that affects T1 and T2 relaxation time. T2 effects predominate and are caused by spin dephasing with a consequent loss of signal intensity. Negative contrast agents include perfluorooctyl bromide [17] , iron oxides [15,18] , and oral magnetic particles [14,15] . Barium sulfate, if used at high concentrations, can be considered a negative contrast agent [19] . Negative contrast agents are more favorable if hyperintense signal of the bowel wall and the surrounding fat tissue signs of acute inflammation have to be detected on T2-weighted sequences [15] . However, magnetic susceptibility on gradient echo sequences may alter image quality on breath-held T1-weighted images.The term "biphasic" recently was introduced to define those substances that show different signal intensities depending on different sequences [20] . The first group (hyperintense signal on T1-weighted images and hypointense signal on T2-weighted images) included manganese and substances that contain manganese, and gadolinium chelates, w...

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MR Imaging in Patients with Crohn Disease: Value of T2- versus T1-weighted Gadolinium-enhanced MR Sequences with Use of an Oral Superparamagnetic Contrast Agent

Abstract: T2-weighted MR can depict Crohn disease lesions and help assess mural and transmural inflammation with the same accuracy as gadolinium-enhanced T1-weighted MR. Combination of gadolinium-enhanced T1- and T2-weighted sequences is useful in the assessment of Crohn disease.

Cited by 250 publications

References 30 publications

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Surgery and diagnostic imaging in abdominal Crohn’s disease

Updating magnetic resonance imaging of small bowel: Imaging protocols and clinical indications

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