mri of the gastrointestinal tract: crohn’s disease...25 gastrointestinal tract mri summary – ibd...
TRANSCRIPT
![Page 1: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/1.jpg)
1
MRI of the Gastrointestinal Tract:
Crohn’s Disease
Diego R. Martin, M.D., Ph.D. The Cosden Professor and Chairman
Department of Radiology The University of Arizona College of Medicine
Tucson
![Page 2: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/2.jpg)
2
Gastrointestinal Tract MRI
Can be performed using standard
abdominal imaging sequences
Highly sensitive and specific for active
inflammation
IBD
*-itis
Acute abdomen-pelvis
![Page 3: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/3.jpg)
3
Methodology Take-Home Points
IBD – Method of choice (in centers w experience)
Most important images SST2 -/+FS
3D GRE Gad
TFISP
MRI Bowel
![Page 4: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/4.jpg)
4
T2-Weighted Imaging
Single Shot (HASTE, SSFSE, sSH)
Optimization
Parallel Processing with surface coils (iPAT,
ASSET, SENSE)
SPAIR fat suppression
Gastroenterology 2007;133:385-90
JMRI 2008;28:113-40
JMRI 2008;27:1448-54
![Page 5: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/5.jpg)
5
2-Monitor Layout: CorT2 CorT2FS AxT2 AxT2FS SagT2 HiResT2
Cor 3D gre Pre Arterial Venous Delayed Cor-Del
SPAIR-T2 single shot - JMRI 2008;27(6):1448-54
![Page 6: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/6.jpg)
6
TFISP
Crohn’s Disease – Five Pillars of Diagnostics
Gastroenterology 2007;133:385-90
JMRI 2008;28(5):113-40
![Page 7: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/7.jpg)
7
Crohn’s Disease - 1
Scope, Capsule and Biopsy Sensitivity
Mucosal and only mucosal disease
![Page 8: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/8.jpg)
8
Crohn’s Disease - 2
MRI Sensitivity
Mostly submucosa and deeper disease
![Page 9: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/9.jpg)
9
Crohn’s Disease - 3
Submucosal and deeper disease
Most serious symptoms
Most significant impact on medical therapy
Most significant impact on surgical therapy
![Page 10: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/10.jpg)
10
Crohn’s Disease - 4
Mucosa can heal over deeper disease and
scope evaluation may under-represent
disease extent
![Page 11: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/11.jpg)
11
Crohn’s Disease - 5
Differentiations between CT and MR
Xrays vs. no-xrays
Contracted bowel vs. disease
Inflammation vs. fibrosis
![Page 12: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/12.jpg)
12
Crohn’s Disease - Fibrosis
![Page 13: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/13.jpg)
13
Crohn’s Disease - Inflammation
![Page 14: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/14.jpg)
14
![Page 15: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/15.jpg)
15
Crohn’s Disease
![Page 16: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/16.jpg)
16
Crohn’s Disease
![Page 17: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/17.jpg)
17
Crohn’s Disease
![Page 18: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/18.jpg)
18
Crohn’s Disease - Treated
![Page 19: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/19.jpg)
19
Crohn’s Disease
![Page 20: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/20.jpg)
20
True FISP
Crohn’s Disease - Fistula
![Page 21: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/21.jpg)
21
Intractable RLQ Pain
![Page 22: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/22.jpg)
22
![Page 23: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/23.jpg)
23
![Page 24: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/24.jpg)
24
![Page 25: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/25.jpg)
25
Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease
1. Inflammation – Fat Sat Single shot T2 SPAIR is
vital
2. Fibrosis – Delayed Gd uptake but no inflammation
(no increased signal on Fat Sat T2)
3. Scope will not assess submucosa seen on MRI
4. Most symptomatic (treated) disease relates to
submucosa
5. MR favored over CT for assessing inflammation vs
fibrosis and for assessing non-distended bowel,
complications (abscess/fistula), and serial studies
![Page 26: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/26.jpg)
26
![Page 27: MRI of the Gastrointestinal Tract: Crohn’s Disease...25 Gastrointestinal Tract MRI Summary – IBD – Crohn’s Disease 1. Inflammation – Fat Sat Single shot T2 SPAIR is vital](https://reader034.vdocuments.us/reader034/viewer/2022042219/5ec583639f76806f70487c0c/html5/thumbnails/27.jpg)
27
MRI of the Gastrointestinal Tract:
Crohn’s Disease
Diego R. Martin, M.D., Ph.D. The Cosden Professor and Chairman
Department of Radiology The University of Arizona College of Medicine
Tucson