MR Enterography

159 Pages·2014·10.556 MB·English

by  Silvio Mazziotti, Alfredo Blandino (auth.)

MR Enterography

Silvio Mazziotti Alfredo Blandino
(cid:129)
MR Enterography

In collaboration with:
Giorgio Ascenti, Tommaso D’Angelo
Silvio Mazziotti Alfredo Blandino
Department of Radiological Department of Radiological
Sciences Sciences
University of Messina University of Messina
Messina Messina
Italy Italy
ISBN 978-88-470-5670-1 ISBN 978-88-470-5675-6 (eBook)
DOI 10.1007/978-88-470-5675-6
Springer Milan Heidelberg New York Dordrecht London
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Foreword
It is with great pleasure and satisfaction that I present this
volume dedicated to the potential contribution of magnetic
resonance to the management of inflammatory bowel diseases,
which are diagnosed today more frequently than in the past.
A uthors wisely describe the technical tips, diagnostic
pearls, and a variety of cases that they collected over the
past 7 years of daily commitment.
T he volume approaches this topic in gradual steps,
allowing an easy consultation also to the novice, while the
expert radiologist will have the opportunity to tailor, mod-
ify, and expand his diagnostic approaches. The iconography
they collected will allow identifying both the most patent
and the subtle signs of the disease in order to allow accu-
rate speculations regarding the stage, predict its evolution,
and evaluate the response to therapy.
The text, of straightforward comprehension in all its sec-
tions, can offer interesting hints to the reader even if not a
radiologist.
v
vi Foreword
My personal appreciation for the rigorous approach of
their research is widely deserved by the authors between
the most motivated and skilled colleagues of the Department
of Diagnostic Imaging that I have the honor to direct.
I express to them my sincere congratulations.
Emanuele Scribano,
Head of Department of Radiological Sciences,
University of Messina,
Messina, Italy
Contents
1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Part I MR Enterography: Technique and Anatomy
2 Technique. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
2.1 Enteric Contrast Agents . . . . . . . . . . . . . . . . 9
2.2 Patient’s Preparation and Positioning. . . . . 13
2.3 Protocols and Sequences. . . . . . . . . . . . . . . . 19
2.3.1 Half-Fourier Acquisition
Single-Shot Turbo Spin Echo
(HASTE). . . . . . . . . . . . . . . . . . . . . . . 20
2.3.2 Balanced Steady-State Free
Precession (Balanced SSFP). . . . . . . 21
2.3.3 Pre- and Post-contrast
T1-Weighted Ultrafast Gradient
Echo. . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4 Spasmolytics . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.5 Intravenous Contrast Agent. . . . . . . . . . . . . 30
2.6 Advanced MR Techniques . . . . . . . . . . . . . . 31
2.6.1 MR Fluoroscopy. . . . . . . . . . . . . . . . . 32
2.6.2 Cine MR . . . . . . . . . . . . . . . . . . . . . . . 33
2.6.3 Diffusion-Weighted Imaging. . . . . . . 37
2.6.4 Perfusion (DCE-MRI). . . . . . . . . . . . 38
2.7 Perianal Imaging. . . . . . . . . . . . . . . . . . . . . . . 40
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
vii
viii Contents
3 Normal MR Anatomy . . . . . . . . . . . . . . . . . . . . . . 45
3.1 Normal MR Anatomy of Duodenum
and Small Bowel. . . . . . . . . . . . . . . . . . . . . . . 45
3.2 Normal MR Anatomy of Sphincters
and Perianal Region. . . . . . . . . . . . . . . . . . . . 48
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Part II MR Enterography: Clinical Applications
4 MR Findings in Crohn’s Disease . . . . . . . . . . . . . 57
4.1 Wall Thickening . . . . . . . . . . . . . . . . . . . . . . . 60
4.2 Ulcerations . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
4.3 Increased Vascularity. . . . . . . . . . . . . . . . . . . 70
4.4 Patterns of Wall Enhancement. . . . . . . . . . . 71
4.5 Perienteric Inflammation . . . . . . . . . . . . . . . 81
4.6 Reactive Adenopathy . . . . . . . . . . . . . . . . . . 83
4.7 Mesenteric Fibrofatty Proliferation. . . . . . . 86
4.8 Penetrating and Stricturing
Patterns in CD . . . . . . . . . . . . . . . . . . . . . . . . 87
4.8.1 Penetrating Disease. . . . . . . . . . . . . . 88
4.8.2 Fibrostenosing Disease . . . . . . . . . . . 94
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
5 Extraintestinal Complications. . . . . . . . . . . . . . . . 103
5.1 Hepatobiliary Complications . . . . . . . . . . . . 104
5.1.1 Primary Sclerosing Cholangitis. . . . . 104
5.1.2 Gallstone Disease. . . . . . . . . . . . . . . . 107
5.1.3 Liver Abscess . . . . . . . . . . . . . . . . . . . 109
5.1.4 Portal Vein Thrombosis. . . . . . . . . . . 109
5.2 Pancreatic Complications . . . . . . . . . . . . . . . 111
5.3 Genitourinary Complications. . . . . . . . . . . . 113
5.3.1 Ureteral Obstruction. . . . . . . . . . . . . 113
5.3.2 Nephrolithiasis . . . . . . . . . . . . . . . . . . 113
5.3.3 Genitourinary Tract Fistulas. . . . . . . 116
Contents ix
5.4 Musculoskeletal and Cutaneous
Manifestation . . . . . . . . . . . . . . . . . . . . . . . . . 116
5.5 Peritoneal Involvement. . . . . . . . . . . . . . . . . 120
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
6 Perianal Complications . . . . . . . . . . . . . . . . . . . . . 127
6.1 Classification of Fistulas . . . . . . . . . . . . . . . . 128
6.2 MRI in Perianal CD. . . . . . . . . . . . . . . . . . . . 130
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
7 Other Indications for MRE. . . . . . . . . . . . . . . . . . 143
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148