Cielma Tara,  Durfee Teela,  Bulas Dorothy,  Loomis Judyta,  Adeyiga Adebunmi,  Bandarkar Anjum

Final Pr. ID: Poster #: EDU-003 (T)

Bowel ultrasound is a critical component of gastrointestinal evaluation. Serial examination allows real-time assessment of disease progression or improvement, and assists the clinician in therapeutic decision making and clinical management.

The goals of this exhibit are:
1. Describe the technical approach of performing bowel ultrasound.
2. Review tips, and up to date technology that assist in optimizing studies.
3. Discuss sonographic appearance of various pathologies.
4. Review future potential techniques and applications including utility of Doppler flow and contrast enhanced ultrasound. Read More

Authors:  Cielma Tara , Durfee Teela , Bulas Dorothy , Loomis Judyta , Adeyiga Adebunmi , Bandarkar Anjum

Keywords:  gastrointestinal disorder, inflammatory bowel disease, bowel

Adu John,  Watson Tom

Final Pr. ID: Poster #: EDU-024

The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are multifaceted disorders as a consequence of complex interplay between genetic, environmental and immunological factors, leading to a dysregulated immune response of the host intestinal bacteria. In children both the mucosal immune system and the intestinal microflora are still developing. Taken together, it seems that patients with early onset IBD (EO-IBD) are a unique subset within IBD with particular gene defects, phenotypic appearance, drug responsiveness and immune pathology.
Imaging plays a key role in the diagnosis and follow-up of EO-IBD, with MRI enterography being the gold standard in modern IBD practice, largely because of its ability to provide excellent spatial resolution without ionising radiation. EO-IBD can also be elegantly demonstrated on ultrasound and can be used a complimentary imaging tool in both the diagnostic workup and follow up imaging.
The aims of this educational exhibit are to:
(i) Provide a pictorial review of the key imaging finding of EO-IBD as demonstrated on MRI and ultrasound.
(ii) Review the imaging techniques and protocols for MR enterography as applied to EO-IBD.
(iii) Discuss the role of genetic mutations and innate immune defects in the pathophysiology of EO-IBD. Read More

Authors:  Adu John , Watson Tom

Keywords:  Inflammatory bowel disease, diarrhoea, interleukin-10, crohns disease, ulcerative colitis

Joshi Hena,  Alazraki Adina,  Rostad Bradley

Final Pr. ID: Poster #: EDU-024

Ulcerative colitis (UC) and Crohn disease are chronic, immune-mediated, inflammatory disorders of the gastrointestinal tract collectively referred to as inflammatory bowel disease (IBD). As many of 20-25% of patients with IBD initially present in childhood or adolescence, and the incidence of pediatric IBD is increasing. IBD primarily affects the bowel, but other organs can be involved. Nearly one-third of patients will have at least one extra-intestinal manifestation. Some extra-intestinal manifestations, such as that between UC and primary sclerosing cholangitis (PSC), are well-established. Others are less understood and may mimic more common pathology, particularly infection. Therefore, pediatric radiologists must become familiar with these extra-intestinal manifestations and consider the diagnosis of IBD as the etiology for their pathology. Read More

Authors:  Joshi Hena , Alazraki Adina , Rostad Bradley

Keywords:  inflammatory bowel disease, ulcerative colitis, Crohn disease

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

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