An-Najah Staff

Dark-lumen MR colonography combining a water enema with intravenous contrast administration is a rapidly evolving, minimally invasive method of evaluating the entire colon (1-2). Results of several preliminary series indicate that this technique has a high sensitivity for detection of colorectal cancer and significant polyp lesions as well as inflammatory disease of the bowel (3). Since bowel movements are depressed during the examination a digital subtraction technique comparable to vascular studies might be applicable and facilitate detection of regions with increased contrast uptake

MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy.