Pediatr Gastroenterol Hepatol Nutr.  2015 Sep;18(3):149-159. 10.5223/pghn.2015.18.3.149.

Pediatric Magnetic Resonance Enterography: Focused on Crohn's Disease

• Lee SM
• Kim WS
• Choi YH

• KMID: 2068791
• DOI: http://doi.org/10.5223/pghn.2015.18.3.149

Abstract

Crohn's disease is a chronic idiopathic inflammatory disease of the intestines characterized by frequent relapse and remission. It often develops in children and adolescents, who are vulnerable to repeated exposure to ionizing radiations. Magnetic resonance enterography (MRE) is an increasingly important radiation-free imaging modality that is used to evaluate pediatric patients with Crohn's disease. MRE can evaluate extraluminal and extraintestinal abnormalities as well as the status of the bowel wall. In addition, MRE has an advantage in the evaluation of the small bowel involvement. MRE can be used for the initial diagnosis of Crohn's disease, and can aid in the assessment of disease activity and complications such as penetrating and fibrostenotic diseases. The aims of this article are to review the MRE technique for obtaining diagnostic and high-quality images and to discuss interpretations of imaging findings in patients with Crohn's disease.

Keyword

Crohn disease; Child; Adolescent; Magnetic resonance imaging; Magnetic resonance enterography

MeSH Terms

Adolescent
Child
Crohn Disease*
Diagnosis
Humans
Intestines
Magnetic Resonance Imaging
Radiation, Ionizing
Recurrence

Figure

• 

  Fig. 1 Active inflammatory subtype in a 15-year-old patient with Crohn's disease. (A) Coronal balanced steady-state free precession (SSFP) image shows a thick edematous bowel wall of the ascending colon (C). The engorged mesenteric vascular structures, which are oriented perpendicular to the affected bowel wall, are in the shape of a comb (arrowheads). (B) Coronal balanced SSFP image shows multiple enlarged mesenteric lymph nodes (arrows) adjacent to the affected ileal segments (I).

• 

  Fig. 2 Active inflammatory subtype in a 10-year-old patient with Crohn's disease. (A) Axial T2-weighted single-shot image shows the thickened bowel wall (arrowheads) of the distal ileum. (B) Axial contrast-enhanced fat-suppressed T1-weighted image shows intense and layered enhancement (arrows). The mesenteric vascular structures are also engorged and appear as multiple enhancing dots adjacent to the inflamed segments (comb sign) (open arrows). (C) Axial diffusion weighted magnetic resonance images shows hyperintensity (restricted diffusion) in the inflamed distal ileum (arrows). (D) Apparent diffusion coefficient (ADC) map shows low ADC values in the inflamed segments (arrows).

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  Fig. 3 Active inflammatory subtype in a 18-year-old patient with Crohn's disease. Coronal (A) and axial (B) T2-weighted single-shot image shows intramural hyperintensities (asterisk) in the terminal ileum (lumen: L, bowel wall: arrowheads), which is indicative of submucosal edema and inflammation. Note hazy signal intensity in the perienteric proliferated mesenteric fat (M), presumably due to mesenteric inflammation.

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  Fig. 4 Active inflammatory subtype in an 11-year-old patient with Crohn's disease. (A) Axial T2-weighted single-shot image shows marked wall thickening (arrows) of the cecum (C) and terminal ileum (T) with hazy signal intensity in the surrounding mesenteric fat (M). (B) Axial contrast enhanced fat-suppressed T1-weighted image shows intense homogenous patterns of enhancement in the affected bowel segments. Multiple enhancing nodular lesions are present within the lumen of the cecum and terminal ileum, indicating pseudopolyps (arrowheads).

• 

  Fig. 5 Active inflammatory subtype in a 15-year-old patient with Crohn's disease. (A) Coronal T2-weighted single-shot image shows a thickened bowel wall (arrows) with perienteric fluid collection around the terminal ileum (open arrow). (B) Coronal contrast enhanced fat-suppressed T1-weighted image shows homogenous pattern of enhancement in the ileal segments (I) compared to the adjacent normal bowel. The comb sign (arrowheads) and multiple reactive mesenteric lymph nodes (open arrows) are also present.

• 

  Fig. 6 Active inflammatory subtype in a 15-year-old patient with Crohn's disease. (A) Axial T2-weighted single-shot image shows multiple reactive lymph nodes with increased signal intensity (asterisks) adjacent to the edematous thickened wall of the cecum and terminal ileum (arrow). (B) Axial contrast enhanced fat-suppressed T1-weighted image shows hyper-enhancement of the bowel wall and mesenteric lymph nodes (asterisks). The surrounding mesenteric fat shows hazy enhancement due to inflammatory fat stranding (open arrows). (C) Axial diffusion weighted magnetic resonance images shows hyperintensity (restricted diffusion) in the inflamed cecum (arrow) and lymph nodes (asterisks).

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  Fig. 7 Fistulizing and perforating subtype in a 16-year-old patient with Crohn's disease. (A) Axial contrast enhanced fat-suppressed T1-weighted image shows fluid collection with avid rim enhancement. This rim-enhancing fluid collection was confirmed to be an abscess (asterisk) during surgery. Note signal void caused by gas (arrowhead) within the abscess (air-fluid level). The terminal (T) and proximal ileum (I) display intense enhancement (arrows) due to active inflammation. The engorged mesenteric vascular structures, which are oriented perpendicular to the proximal ileum, are shown (comb sign). (B) Coronal balanced steady-state free precession image shows linear structures (sinus tract) (open arrow) extending from the terminal ileum (T) to the abscess (asterisk). (C) Axial diffusion weighted magnetic resonance image shows hyperintensity (restricted diffusion) of the terminal ileum (T) and abscess (asterisk) in addition to the sinus tract (open arrow).

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  Fig. 8 Reparative and regenerative subtype in a 17-year-old patient with Crohn's disease. Axial contrast-enhanced fat-suppressed T1-weighted image shows a non-enhancing ovoid nodular lesion (arrow) within the ascending colon, which is indicative of a regenerative polyp.

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