Magnetic Resonance Imaging of the Gastrointestinal Tract

Russell N. Low1

1 Sharp and Children's MRI Center, San Diego, California
Publication Name:  Current Protocols in Magnetic Resonance Imaging
Unit Number:  Unit A29.1
DOI:  10.1002/0471142719.mia2901s12
Online Posting Date:  July, 2004
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Abstract

MRI provides comprehensive information on gastrointestinal diseases, including infectious, inflammatory, and malignant processes. We employ a set protocol incorporating breath-hold SS RARE imaging combined with gadolinium-enhanced, fat-suppressed SPGR imaging in the transverse and coronal planes. Bowel distension is accomplished with inexpensive water-soluble intraluminal contrast agents.

Keywords: Crohn's disease; gadolinium-enhanced; breath-hold sequences

     
 
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Table of Contents

  • Basic Protocol
  • Commentary
  • Literature Cited
  • Figures
  • Tables
     
 
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Materials

 Basic Protocol
 Materials
  • Normal saline (0.9% NaCl), sterile, 40 ml minimum
  • Extravascular contrast agent (e.g., Magnevist, Omniscan, or Prohance)
  • Water with mannitol or Metamucil

For additional items, see Table A29.1.1.
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Figures

  •  FigureFigure A29.1.1 (A) Transverse SS-FSE image through the pelvis shows distension of the bowel with water-soluble contrast material. (B) Transverse fat-suppressed, gadolinium-enhanced SPGR image through the pelvis shows moderate thickening and marked enhancement of the terminal ileum in the right lower quadrant (arrow). In retrospect, this same loop of ileum shows mural thickening on the SS-FSE image (A). The conspicuity of enhancement with gadolinium on (B) makes it much easier to appreciate the abnormality. Good bowel distension and homogeneous fat suppression are important features of this protocol.
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  •  FigureFigure A29.1.2 (A) Coronal gadolinium-enhanced SPGR image shows terminal ileitis. Moderate mural thickening and marked enhancement of the terminal ileum (lower arrow) are present. The coronal images are useful for relationship of the terminal ileum and cecum. Note the distension of the colon and small bowel with water-soluble contrast material (upper arrow). (B) Small-bowel barium examination shows a “string sign” with marked narrowing and distortion of the terminal ileum (arrow).
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  •  FigureFigure A29.1.3 Fat-suppressed, gadolinium-enhanced SPGR image through the pelvis shows diffuse colitis with moderate mural thickening and marked enhancement of the colon (arrows). Findings correlate with ulcerative colitis.
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  •  FigureFigure A29.1.4 MR hydrogram in a patient with long-standing Crohn's disease shows an ahaustral colon with a chronic stricture at the junction of the descending and sigmoid colon. This 10-cm thick slice is obtained in less than 1 sec and shows the water-soluble contrast material in the small bowel and colon.
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Videos

Literature Cited

Literature Cited
    Kettritz, U., Isaacs, K., Warshauer, D.M., and Semelka, R.C. 1995a. Crohn's disease: Pilot study comparing MRI of the abdomen with clinical evaluation. J. Clin. Gastroenterol. 21:249-253.
    Kettritz, U., Shoenut, J.P., and Semelka, R.C. 1995b. MR imaging of the gastrointestinal tract. Magn. Reson. Imaging Clin. N. Am. 3:87-98.
    Lee, J.K.T., Marcos, H.B., and Semelka, R.C. 1998. MR Imaging of the small bowel using the HASTE sequence. Am. J. Roentgenol. 170:1457-1463.
    Low, R.N. and Francis, I.R. 1997. MR imaging of the gastrointestinal tract with IV gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. Am. J. Roentgenol. 169:1051-1059.
    Low, R.N., Francis, I.R., Politoske, D., and Bennett, M. 1999. Crohn's disease evaluation: Comparison of contrast-enhanced MR imaging and single phase helical CT scanning. J. Magn. Reson. Imaging 11:127-135.
    Low, R.N., Sebrechts, C.P., Politoske, D.A., Bennett, M.T., Flores, S., Snyder, R.J., and Pressman, J.H. 2002. Crohn Disease with endoscopic correlation: Single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology 222:652-660.
    Maglinte, D.D., Gourtsoyiannis, N., Rex, D., Howard, T.J., and Kelvin, F.M. 2003. Classification of small bowel Crohn's subtypes based on multimodality imaging. Radiol. Clin. North Am. 41:285-303.
    Prassopoulos, P., Papanikolaou, N., Grammatikakis, J., Rousomoustakaki, M., Maris, T., and Gourtsoyiannis, N. 2001. MR enteroclysis imaging of Crohn disease. Radiographics 21:Spec No:S161-S172.
    Regan, F., Beall, D.P., Bohlman, M.E., Khazan, R., Sufi, A., and Schaefer, D.C. 1998. Fast MR imaging and the detection of small-bowel obstruction. Am. J. Roentgenol. 170:1465-1469.
    Schunk, K. 2002. Small bowel magnetic resonance imaging for inflammatory bowel disease. Top. Magn. Reson. Imaging 13:409-425.
    Shellock, F.G. 2001. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
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