Objectives
To develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease.

/pdf/the-first-joint-esgar-espr-consensus-statement-on-the-2tt4i9k1a4.pdf

The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating a variety of bowel diseases, most commonly inflammatory bowel disease which is increasing in prevalence Inflammatory bowel disease is composed of 2 related, but distinct disease entities: Crohn disease (CD) and ulcerative colitis In ulcerative colitis, inflammation is generally limited to the mucosa and invariably involves the rectum, and often the more proximal colon CD is typified by transmural inflammation with skip lesions occurring anywhere from the mouth to anus, but characteristically involves the terminal ileum The transmural involvement of CD may lead to debilitating ulceration and, ultimately, development of sinus tracts, which can be associated with abscesses and fistulae as extraenteric manifestations of the disease Because much of the small bowel and extraenteric disease cannot be adequately assessed with conventional endoscopy, imaging plays a crucial role in initial diagnosis and follow-up MRE does not use ionizing radiation which is important for these patients, many of which present earlier in life and may require multiple imaging examinations In this article, we review the clinical indications, patient preparation, and optimal technique for MRE We also discuss the role and proper selection of intravenous gadolinium-based contrast material, oral contrast material, and antiperistaltic agents, including pediatric considerations Finally, we review the recommended and optional pulse sequence selection, including discussion of a "time-efficient" protocol, reviewing their utility, advantages, and limitations Our hope is to aid the radiologist seeking to develop a robust MRE imaging program for the evaluation of bowel disease

State of the Art MR Enterography Technique.

OBJECTIVE. The cross-sectional characterization of duodenal abnormalities is plagued with inadequacy, a reflection of the meandering course of this segment of the bowel. We consider the imaging appearance of such abnormalities at MRI small-bowel follow-through, illustrating the typical manifestations of each pathologically confirmed condition.CONCLUSION. MRI small-bowel follow-through allows confident duodenal evaluation because of a combination of sufficient luminal distention and multiplanar versatility. Diseases of the duodenum may have a variety of manifestations at MRI small-bowel follow-through, the knowledge of which may aid in confident noninvasive patient diagnosis.

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.07.3756

Duodenal Abnormalities at MR Small-Bowel Follow-Through

The duodenum is a unique segment of intestine, occupying both intra and extra-peritoneal locations. There is a wide spectrum of abnormalities of the duodenum that range from congenital anomalies to traumatic, inflammatory, and neoplastic entities. The duodenum may be overlooked on cross-sectional imaging due to its location and small size. Duodenal pathologies may, therefore, be missed or wrongly diagnosed. Knowledge about duodenal pathologies and optimal imaging techniques can increase diagnostic yield and permit optimal patient management. Conventionally, the duodenum was evaluated with upper GI studies on fluoroscopy; however, endoluminal evaluation is better performed with endoscopy. Additionally, a broad array of cross-sectional imaging modalities permits comprehensive assessment of the duodenum and surrounding viscera. While endoscopic sonography is increasingly used to locally stage duodenal malignancies, MDCT remains the primary modality widely used in the detection and characterization of duodenal abnormalities. MRI is used as a "problem solving" modality in select conditions. We present a comprehensive review of duodenal abnormalities with an emphasis on accurate diagnosis and management.

Multimodality imaging of diseases of the duodenum

BackgroundDifferent methods for bowel distension prior to magnetic resonance imaging (MRI) examinations were described in recent years.PurposeTo compare orally administered psyllium or locust bean ...

Oral distension methods for small bowel MRI: comparison of different agents to optimize bowel distension.

To date, cross-sectional imaging of the duodenum has a number of inadequacies, most likely a reflection of its tortuous and complex anatomical course, resulting in somewhat suboptimal imaging. The purpose of this study was to describe and assess the feasibility of performing a ‘tubeless’, per-oral, single contrast, hypotonic magnetic resonance (MR) duodenography technique. Secondly, to assess the efficacy of intravenous Buscopan in facilitating duodenal distension at cross-sectional MR imaging. Ten healthy volunteers prospectively underwent MR imaging of the duodenum pre- and post-Buscopan immediately after consuming 1,000 ml of water. Images were qualitatively (using a visual assessment grading scale of 1–3) and quantitatively evaluated with regard to degree of small bowel distension by two observers. The contrast medium was successfully ingested and MR examination was completed in all participants. Quantitatively and qualitatively, the per-oral, hypotonic duodenography technique yielded superior distension scores and was significantly greater in diameter in comparison with the per-oral non-hypotonic duodenography technique (p < 0.003, p < 0.002). Per-oral, single-contrast, hypotonic MR duodenography is a feasible, simple, fast mode of investigation of the duodenum, which does not involve radiation and represents a useful technique in the armamentarium of the radiologist.

Hypotonic MR duodenography with water ingestion alone: feasibility and technique.

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Hypotonic MR duodenography with water ingestion alone: feasibility and technique.