Davila Jorge,  Highmore Kerri,  Miller Elka

Final Pr. ID: Poster #: SCI-064

The objective of this prospective study was to determine the accuracy of MR Enterography (MRE) in the assessment of mucosal healing in patients with Pediatric Crohn’s Disease (PCD) after starting treatment. MARIA and Clermont scores are MRE scores that were originally developed in adult population for the assessment of severity of Crohn's Disease (CD) in correlation to Crohn's Disease Endoscopic Index of Severity (CDEIS). MARIA score has shown close correlation to disease severity of colonic CD and Clermont score has shown close correlation to terminal ileum disease. A few reports have shown correlation of mucosal heling when assess by MRE scores and CDEIS in Adult population, but not work is available in pediatrics. Read More

Authors:  Davila Jorge , Highmore Kerri , Miller Elka

Keywords:  MR Enterography, pediatric crohn's disease

Lanier Michael,  Shetty Anup,  Salter Amber,  Khanna Geetika

Final Pr. ID: Poster #: SCI-011

Gadolinium deposition in normal tissues is an increasingly recognized consequence of intravenous gadolinium contrast agents. Children with inflammatory bowel disease (IBD) undergo frequent surveillance imaging with contrast enhanced MR enterography (MRE).
Purpose: To determine the benefit (if any) of IV contrast in evaluation of IBD by MRE. Read More

Authors:  Lanier Michael , Shetty Anup , Salter Amber , Khanna Geetika

Keywords:  Enterography, Crohn disease, inflammation

Rees Mitchell,  Suman Garima,  Krishnamurthy Ramkumar,  Krishnamurthy Rajesh

Final Pr. ID: Paper #: 010

This study compares the performance of a single free-breathing GRASP sequence to a full C-MRE protocol in pediatric small bowel CD. The high k-trans of affected bowel in CD may allow high spatiotemporal GRASP dynamic contrast-enhanced technique to provide comprehensive diagnostic value in CD, especially in patients with limited breath-hold capacity. Read More

Authors:  Rees Mitchell , Suman Garima , Krishnamurthy Ramkumar , Krishnamurthy Rajesh

Keywords:  Crohn disease, enterography, GRASP

Chaker Salama,  Reid Janet,  Lopez-rippe Julian

Final Pr. ID: Poster #: EDU-041

The purpose of this educational exhibit is to present a systematic 4-sequence hanging protocol and search pattern as an effective method to initially review a pediatric MR enterography (MRE) study prior to thorough interpretation. By analyzing frequently referenced sequences in MRE reports with positive inflammatory bowel disease findings, we identified novel 4-sequence hanging protocol: coronal T2-weighted HASTE (for anatomic orientation), axial fat-saturated fluid-sensitive sequence (for bowel wall thickening/edema), axial diffusion-weighted high b-value sequences (for bowel inflammation and complications), and coronal gradient-recall echo T1-weighted post-contrast (for enhancement). This structured 4-sequence hanging protocol highlights the most pertinent findings and allows for rapid first-pass evaluation to orient novice readers. The exhibit provides an efficient framework for radiology trainees to streamline review of pediatric MREs before proceeding to full detailed interpretation. Read More

Authors:  Chaker Salama , Reid Janet , Lopez-rippe Julian

Keywords:  inflammatory bowel disease, magnetic resonance enterography, hanging protocol

Reddy Nidhi,  Chan Sherwin,  Robinson Amie,  Mardis Neil,  Dahl Amy,  Fickenscher Kristin

Final Pr. ID: Poster #: SCI-017

Inflammatory bowel disease (IBD), including Crohn disease, is a cause of significant morbidity in the pediatric population. Perirectal disease is a Crohn related complication affecting as many as 62% of children. Magnetic resonance enterography (MRE) is being increasingly utilized in characterizing the extent of IBD. Dedicated perirectal disease imaging, such as a T2 SPACE, requires an additional 10-15 minutes of imaging time on an already time constrained modality. The goal of our study was to determine the best imaging protocol for patients without clinically suspicious perirectal disease based on the incidence in this population. Read More

Authors:  Reddy Nidhi , Chan Sherwin , Robinson Amie , Mardis Neil , Dahl Amy , Fickenscher Kristin

Keywords:  Perirectal Disease Imaging, MR Enterography, Pediatric MRI

Chopra Mark,  Watson Tom,  Olsen Øystein

Final Pr. ID: Poster #: CR-023

The incidence of paediatric inflammatory bowel disease (pIBD) is increasing. MR enterography (MRE) is increasingly recognised as the gold standard imaging technique for the small bowel in IBD. The advantages of MRE include the lack of ionising radiation and greater soft tissue definition. It also allows functional information from diffusion sequences and is used for IBD diagnosis, monitoring of disease activity and complications such as abscess, stricture or fistula. Extra-intestinal manifestations can also be identified.

Younger children often need a general anaesthetic (GA) in order to undergo MRI. Excellent distension of the small bowel loops on MRE is essential to aid accurate assessment. As the child cannot drink a large volume of fluid prior to anaesthetic induction, fluid distension is facilitated through insertion of a nasojejunal tube and instillation of fluid via the tube whilst under GA. We present our institutional practice from a large paediatric hospital for performing MR enterography under GA in young children.

A retrospective study of our Radiology Information Service (RIS) was undertaken to identify children under the age of 10 years who underwent MRE under GA between 2010-2015. The anaesthetic charts of these children were obtained and the anaesthetic duration / complications were recorded. The imaging was reviewed to evaluate the MRI quality, degree of distension and report finding. The MR protocol and sequence optimisation will also be discussed.


12 patients were included in the study, aged from 23 months to 10 years.The length of GA time ranged from 110-185 minutes (average 142 minutes) and no significant adverse effects were described. The mean fluoroscopy radiation dosage for NJ insertion was low (8 micrograys) and the success rate was high (91%).
All completed studies were reviewed and oral contrast reached the terminal ileum in 100%. Bowel distension was rated as good or excellent in all cases.

Our institutional experience has shown that MRE under GA with nasojejunal tube enteroclysis is feasible and can safely produce high quality, diagnostic imaging in the young paediatric patient.
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Authors:  Chopra Mark , Watson Tom , Olsen Øystein

Keywords:  MR enterography, Inflammatory bowel disease, general anaesthesia, enteroclysis

Portal Daniel,  Neuman Jeremy

Final Pr. ID: Poster #: CR-013

A 12 year old hispanic male with a past medical history of rectal prolapse presented to the ED from the pediatrician with a Hgb of 4.5 on outpatient lab work. The patient’s mother reports a history of constipation, staying in the bathroom for long periods of time and straining. Additionally the patient has been fatigued and pale for the last year with intermittent bloody diarrhea for the last 3 years.
Inpatient testing included defecography which showed evidence of rectal prolapse. MR enterography revealed wall thickening and hyperenhancement of the rectosigmoid colon, consistent with infectious/inflammatory etiology. Colonoscopy with biopsy was performed and histopathology results were consistent with solitary rectal ulcer syndrome.
The patient was successfully treated conservatively with dietary changes, topical medications and education about bathroom habits.

Solitary rectal ulcer syndrome (SRUS), first described in 1829, is an uncommon, benign disease characterized by clinical history, imaging (including defecography, and MR enterography), colonoscopy and diagnosed by histopathological findings. With an annual prevalence of 1 in 100,000, SRUS is most commonly found in young adults, but also seen in pediatric and geriatric populations.
Clinical presentation usually includes a history of prolonged straining, constipation, lower abdominal pain, rectal bleeding, mucous discharge and rarely rectal prolapse. Solitary rectal ulcer syndrome is actually a misnomer as only 40% of cases present with ulcers; even fewer present with a solitary ulcer. The etiology is not completely understood but is likely multifactorial.
Diagnosis of SRUS is often missed or delayed due to low clinical suspicion, inadequate rectal biopsy or failure to recognize histopathological features of the disease. It is therefore important to recognize solitary rectal ulcer syndrome and the diagnostic features and maximize the likelihood of accurately diagnosing SRUS early on. Read More

Authors:  Portal Daniel , Neuman Jeremy

Keywords:  MR Enterography, Solitary Rectal Ulcer Syndrome, Defecography