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Small Bowel Hydro-MR Imaging for Optimized Ileocecal Distension in Crohn's Disease: Should an Additional Rectal Enema Filling be Performed?

Mon, 2011-05-16 13:02 — Prof. Dr. med. Waleed Ajaj (PhD, Full Professor)
Journal Title, Volume, Page: 
Journal of Magnetic Resonance Imaging Volume 22, Issue 1, pages 92–100, July 2005
Year of Publication: 
2005
Link: 
http://onlinelibrary.wiley.com/doi/10.1002/jmri.20342/abstract
Authors: 
Waleed Ajaj
Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
[email protected]
Thomas C. Lauenstein
Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
Jost Langhorst
Departments of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
Christiane Kuehle
Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
Mathias Goyen
University Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Thomas Zoepf
Departments of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
Stefan G. Ruehm
Department of Radiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California, USA
Guido Gerken
Departments of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
Jorg F. Debatin
University Medical Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Susanne C. Goehde
Departments of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
Preferred Abstract (Original): 

Purpose: To assess the impact of an additional rectal enema filling in small bowel hydro-MRI in patients with Crohn’s disease.
Materials and Methods: A total of 40 patients with known Crohn’s disease were analyzed retrospectively: 20 patients only ingested an oral contrast agent (group A), the other 20 subjects obtained an additional rectal water enema (group B). For small bowel distension, a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol was used. In all patients, a breathhold contrast-enhanced T1w three-dimensional volumetric interpolated breathhold examination (VIBE) sequence was acquired. Comparative analysis was based on image quality and bowel distension as well as signal-to-noise ratio (SNR) measurements. MR findings were compared with those of conventional colonoscopy, as available (N  25).
Results: The terminal ileum and rectum showed a significantly higher distension following the rectal administration of water. Furthermore, fewer artifacts were seen within group B. This resulted in a higher reader confidence for the diagnosis of bowel disease, not only in the colon, but also in the ileocecal region. Diagnostic accuracy in diagnosing inflammation of the terminal ileum was 100% in group B; in the nonenema group there were three false-negative diagnoses of terminal ileitis.
Conclusion: Our data show that the additional administration of a rectal enema is useful in small bowel MRI for the visualization of the terminal ileum. The additional time needed for the enema administration was minimal, and small and large bowel pathologies could be diagnosed with high accuracy. Thus, we suggest that a rectal enema in small bowel MR imaging be considered

w.ajaj's picture

Oral Contrast Agents For Small Bowel MRI: Comparison of Different Additives To Optimize Bowel Distension

Mon, 2011-05-16 09:10 — Prof. Dr. med. Waleed Ajaj (PhD, Full Professor)
Journal Title, Volume, Page: 
Eur Radiol (2004) 14:458–464
Year of Publication: 
2004
Link: 
http://link.springer.com/article/10.1007%2Fs00330-003-2177-0
Authors: 
Waleed Ajaj
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Hufelandstrasse 55, Essen, 45122, Germany
Current Affiliation: 
Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
[email protected]
Susanne C. Goehde
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
Hubert Schneemann
Institute of Pharmacy & Pharmaceutical Sciences, University Hospital Essen, Essen, Germany
Stefan G. Ruehm
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
Jörg F. Debatin
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
Thomas C. Lauenstein
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
R. Jeyrani
Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany
Preferred Abstract (Original): 

The purpose of this study was to compare two osmotic carbohydrate sugar alcohols (mannitol 2.5% and sorbitol 2.5%, 2.0%, and 1.5% watery solutions) in combination with 0.2% locust bean gum (LBG) for small bowel distension for MR imaging. Small bowel distension was quantified on coronal 2D TrueFISP images by measuring the diameters of 16 small bowel loops in each of 12 healthy subjects (age range 31–55 years). Additionally, the grade of small bowel distension was rated qualitatively. Patient acceptance concerning nausea, vomiting, flatulence, and diarrhea was noted for each solution, and all results were compared by a Wilcoxon test or t test, respectively. The ingestion of water combined with LBG and either 2.5% mannitol or 2.0% sorbitol showed the best distension of the small bowel. The lowest side effect rate was observed following ingestion of sorbitol in a concentration of 2.0 and 1.5%. Based on these data, we recommend a combination of LBG and 2% sorbitol use for optimal bowel distension and minimal side effects resulting in enhanced patient acceptance.

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