MRI of the Small Bowel

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.50
Procedures: 1.50
Abdomen and Pelvis: 1.50

Magnetic Resonance Imaging: 4.75
Patient Care: 0.25
Patient Interactions and Management: 0.25
Procedures: 4.50
Body: 4.50

Registered Radiologist Assistant: 3.75
Patient Care: 0.25
Pharmacology: 0.25
Procedures: 3.50
Abdominal Section: 3.50

Radiation Therapy: 3.50
Procedures: 3.50
Treatment Sites and Tumors: 3.50

Outline

1. Introduction
2. Technical Considerations
   1. Enteral Contrast Agents for MR Imaging
   2. MR Techniques: Enterography and Enteroclysis
   3. MR Imaging Protocol and Pulse Sequences
   4. The Use of Intravenous Contrast Material
   5. Image Interpretation
3. Clinical Indications
   1. Crohn Disease
   2. Small-Bowel Neoplasms
   3. Celiac Disease
   4. Small-Bowel Obstruction
4. Conclusion

Objectives

Upon completion of this course, students will:

1. list the methods for evaluating the small bowel
2. know what pathology is best imaged with traditional barium studies
3. list the disadvantages of ultrasound imaging of the bowel
4. be familiar with the wireless capsule endoscopy procedure
5. understand what information CT provides about the small bowel
6. understand what information MRI provides about the small bowel
7. know the characteristics of positive contrast enteral agents
8. name the only negative contrast agent available in the United States
9. know what types of contrast can be created using VoLumen
10. recognize the appearance of biphasic enteral contrast on MR imaging sequences
11. know the characteristics of MR enterography and MR enteroclysis
12. describe the ligament of Treitz
13. understand why a radiologist must be present during bowel distention
14. know how much enteral contrast material to use for MR enterography
15. be familiar with the transit time of enteral contrast media after oral ingestion
16. list the characteristics of MR enteroclysis
17. understand why fasting is important prior to MR enteroclysis or enterography
18. know the benefits positioning the patient in a prone orientation
19. describe what MR scanner attributes are required for enterography or enteroclysis examinations
20. name the reasons for getting adequate anatomic coverage for MR enterography or enteroclysis
21. describe the features of the jejunum
22. identify the contrast seen on balanced gradient-echo MR images
23. know what field of view (FOV) is recommend for most bowel imaging sequences
24. know the medications given to reduce peristalsis of the bowel
25. list reasons for acquiring 3D instead of 2D MR images
26. understand the importance of gadolinium chelate intravenous contrast media in diagnosing Crohn disease
27. be familiar with the use of dynamic contrast-enhanced perfusion imaging
28. know the criteria for diagnosing low-grade stenosis of the bowel
29. know what bowel wall thickness is considered abnormal in a distended small bowel loop
30. identify the causes of reversible and nonreversible lumen narrowing
31. be familiar with the major types of inflammatory bowel disease
32. identify the early changes that are seen with Crohn disease
33. describe the appearance of deep linear ulcers on T2-weighted images
34. be familiar with the imaging-based classification system for Crohn disease
35. identify the most sensitive imaging finding in active Crohn disease
36. name the imaging sequence that best demonstrates the comb sign
37. characterize abscesses in the bowel wall
38. be aware of the limitations of MR imaging in categorizing Crohn disease activity
39. know what the preferred method of small bowel imaging is
40. list the associated signs of malignant forms of small bowel obstruction