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

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Adu John, Watson Tom

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

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. Read More

Meeting name: IPR 2016 Conjoint Meeting & Exhibition , 2016

Authors: Chopra Mark, Watson Tom, Olsen Øystein

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