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How we do it: MR enterography

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Abstract

Magnetic resonance enterography (MRE) now plays a central role in diagnosing pediatric inflammatory bowel disease (IBD), and its role in other intestinal pathologies such as scleroderma is gradually expanding. MRE helps distinguish between Crohn disease and ulcerative colitis, defining extent and severity. Standard MRE protocols can be optimized in children and adolescents to be diagnostic and well tolerated, both of which are important with increasing use of serial MRE in pediatric IBD for monitoring treatment response and evaluating complications. MRI is especially suited to this role given its lack of ionizing radiation. MRE compliance can be improved through patient education. Differing from adult MRE, pediatric MRE protocols use weight-based formulas to calculate oral and intravenous contrast media and antispasmodic agent doses, using either hyoscine-N-butylbromide or glucagon. Nausea is more commonly experienced with glucagon; however vomiting occurs in <10% of children with either agent. Standard and advanced sequences applied in adults are also used in children and adolescents. These include static and cinematic balanced steady-state free precession sequences, single-shot T2-weighted sequences, diffusion-weighted imaging and pre- and post-contrast 3-D T1-weighted gradient echo sequences. Magnetization transfer imaging and quantitative assessment of bowel to distinguish inflammation and fibrosis are not yet standard in pediatric MRE, but show promise.

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Authors and Affiliations

  1. Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada

    Mary-Louise C. Greer

  2. Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada

    Mary-Louise C. Greer

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  1. Mary-Louise C. Greer
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Correspondence to Mary-Louise C. Greer.

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The author has no financial interests or investigational uses to disclose. Off-label use of hyoscine-N-butylbromide is discussed.

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Appendix 1

3% Sorbitol oral contrast preparation. Abbreviation: W/V - weight per volume. (GIF 26 kb)

High resolution image (TIF 47139 kb)

Supplementary online material

(movie clip) Coronal cine steady-state free precession image acquired at 1.5 T demonstrates a distal ileal stricture in a 17-year-old girl with Crohn disease. Each image slice is acquired as 40 images over 12 seconds, with 5–7 slices at a slice thickness of 10–15 mm (MOV 1404 kb)

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Greer, ML.C. How we do it: MR enterography. Pediatr Radiol 46, 818–828 (2016). https://doi.org/10.1007/s00247-016-3596-9

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  • DOI: https://doi.org/10.1007/s00247-016-3596-9

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