We studied 77 patients with terminal ileum Crohn's disease(18-76 yrs, average 45,71 ys),without fasting, after bowel oral distension with polyethyleneglycol solution.
We studied patients in supine position,
with 1.5T MR scanner (Magnetom Avanto; Siemens,
Erlangen,
Germany) with high performing gradients (45 mT/m).
We based MR-assessment of disease activity on:
- dynamic motility, (cine-true-FISP on coronal plane) obtaining 10 images of the same slice in 7 seconds and dispensing 40 mg N-butyl-scopolamine i.v.
(Buscopan; Boehringer,
Ingelheim,
Germany) to reduce bowel peristalsis;
- basal study and DWI, through breath-hold sequences like T2-weighted (HASTE,
on axial and coronal planes),T1weighted unspoiled GRE (TRUE-FISP,on axial and coronal planes)and free-breathing DWI (on axial plane; EPI b = 50,
400,
800 s/mm2);
- dynamic enhancement,
using BH-T1weighted spoiled GRE (FLASH FS) on axial plane, giving to patient 0.1 mmol/kg (0.2 mL/kg) Gd-chelate i.v.,
BH T1-weighted spoiled GRE (FLASH FS) on axial plane,
serially acquired(10 times),
BH T1-weighted spoiled GRE (FLASH FS) on axial and coronal planes, as a late phase on the whole abdomen. The entire examination had a duration of about 25 minutes (range 21-28 min).
So MR-assessment of disease activity included:
- Motility and morphology of small bowel and perivisceral structures (cine-true-FISP,
true-FISP,
HASTE T2weighted sequences).
- Parietal signal intensity in DWI (Qualitative evaluation) and ADC (Quantitative evaluation)
- Dynamic assessment of parietal contrast enhancement (D-CE-FLASH T1weighted-sequences)