An-Najah Staff

PURPOSE
MRI of the small bowel has become an established method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both small and large bowel. Thus, aim of this study was to evaluate the practicability of small bowel MRI combined with large bowel imaging in patients with inflammatory bowel disease.
METHOD AND MATERIALS
26 patients with suspected inflammatory bowel disease were included in this study. MRI was performed following an eight six fast. To provide sufficient small bowel distension, patients ingested 1500ml of a solution containing 2.5% mannitol and 0.2% locust bean gum (LBG). Ingestion started 45 minutes prior to the MR examination. In addition to the small bowel visualization, the colon was rectally filled with 1500 ml of tap water. MR examinations were performed on a 1.5 T system (Magnetom Sonata, Siemens). Paramagnetic contrast was intravenously administered at a dosage of 0.2 mmol/kg Gd-BOPTA and a flow rate of 3ml/s. Before and after a delay of 75 seconds a T1 weighted 3D gradient echo data set was acquired over 22 seconds in a single breathhold. All patients underwent a conventional colonoscopy within 3 days of the MR examination.
RESULTS
The oral ingestion of mannitol and LBG resulted in an excellent small bowel distension in 24 out of 26 patients. The rectal application of water allowed an assessment of the colonic wall in all 26 patients. Endoscopy and histology rated 13 patients to suffer from acute inflammatory bowel disease (Crohn s disease n=10, ulcerative colitis ulcerosa n=3). Post-inflammatory lesions, such as fibrotic strictures of the terminal ileum were seen in four patients. MRI confirmed acute inflammation in 12 out of 13 patients as well as post-inflammatory strictures in four patients. Furthermore, MRI detected inflammatory lesions in the jejunum and proximal ileum in three additional patients.
CONCLUSIONS
Small bowel MRI in conjunction with the oral application of mannitol and locust bean gum is practicable. The additional rectal administration of water allows the visualization of both small and large bowel. Hence, MRI is an appropriate tool for the diagnosis and follow-up of patients with inflammatory bowel diseases.