MR Enteroclisis Findings

Early lesions of Crohn's disease such as blunting, flattening, thickening, distortion and straightening of the valvulae conniventes and tiny aphthae were clearly shown at conventional enteroclysis, but they were not consistently depicted with MR enteroclysis due to its inadequate spatial resolution. The valvulae conniventes were shown to their best advantage and distortion of the mucosal folds was easily detected with MR enteroclysis.

The characteristic discrete longitudinal or transverse ulcers of Crohn's disease could be shown at MR enteroclysis, provided there was satisfactory disten-tion of the bowel. MR enteroclysis was less sensitive than conventional enteroclysis in the detection of linear ulcers due to low spatial resolution and lack of compression techniques. Thin high-signal-intensity lines within the bowel wall on true FISP MR images represented linear ulcers. Cobblestoning was caused mostly by a combination of longitudinal and transverse ulceration and was easily shown with MR ente-roclysis. The true FISP sequence was superior to HASTE in showing linear ulcers, cobblestoning, and intramural tracts, while the three-dimensional gradient echo sequence was less satisfactory in depicting such lesions smaller than 3 mm in diameter.

Bowel-wall thickening was clearly shown with all MR enteroclysis sequences (Figs. 2,3). The thickened wall had moderate signal intensity on true FISP images and could be easily differentiated from the black boundary artifact. Bowel-wall thickness and length of small-bowel involvement could be measured on MR enteroclysis images. Narrowing of the lumen and associated prestenotic dilatation were easily recognized on MR enteroclysis images obtained with all sequences (Figs. 2, 3). Asymmetric involvement, pseudo-diverticula formation, and skip or multiple lesions were easily depicted via MR ente-roclysis.

Crohn Disease Valvulae Conniventes

Fig. 3. A 57-year-old female with active Crohn's disease. a, b Axial fat-suppressed true-FISP images show severe thickening of the terminal ileum with luminal stenosis and fibro-fatty proliferation. c, d After Gadolinium administration fat suppressed Tl-weighted spoiled gradient echo images show enhancement of the bowel wall due to Crohn's disease activity

Fig. 3. A 57-year-old female with active Crohn's disease. a, b Axial fat-suppressed true-FISP images show severe thickening of the terminal ileum with luminal stenosis and fibro-fatty proliferation. c, d After Gadolinium administration fat suppressed Tl-weighted spoiled gradient echo images show enhancement of the bowel wall due to Crohn's disease activity

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