The value of MR enteroclysis with air infusion in the diagnosis of small bowel disease / 中华放射学杂志

ABSTRACT

Objective To investigate the value of MR enteroclysis with air infusion in the diagnosis of small bowel disease.Methods Sixteen patients with suspected small bowel disease, but without acute inflammatory disease or bowel obstruction, received MR enteroclysis with air infusion.There were 12 males and 4 females, and their age ranged from 17 to 75 years.10 patients had abdominal pain, 4 with melena or blood stool, and 2 with diarrhea.The longest course was 7 years, and the shortest 1 week.Before MR imaging, a nasoenteric catheter was inserted into the distal part of duodenum, and about 1000 ml of air was infused through the tube to distend the small bowel.20 mg of IV anisodamine was given to reduce small-bowel peristalsis.All patients were imaged with fat-saturated Gd-DTPA enhanced coronal and axial T 1-weighted spin-echo (SE) sequence and fast spoiled gradient echo (FSPGR) sequence.Comparison between the diagnosis of MRI and the results of surgery, pathology or clinic was performed to assess the sensitivity and specificity of MRI.Results 5 cases were normal, 6 with Crohn disease, 2 with gastric intestinal stromal tumor (GIST), and 1 each of lymphoma, tuberculosis and irritable bowel syndrome.The lumen of normal small bowel in MR enteroclysis was no signal, the wall was outlined as middle signal by intraluminal air and surrounding air-distended bowel and was between 1-3 mm thick, and the diameter of the lumen was between 17-28 mm.Crohn disease showed segmental mural thickening, increased enhancement, luminal stricture, and even extraluminal inflammatory mass or fistula.Intestinal tuberculosis invaded the distal section of ileum, cecum, and the proximal ascending colon, the wall thickened and enhanced apparently, and cecum and proximal ascending colon shortened.GIST showed a mass that was iso-signal on T 1WI, high signal on T 2WI, and enhanced significantly after IV Gd-DTPA.1 recurrent lymphoma of ileum showed mural thickening and increased enhancement but no stenosis.1 irritable bowel syndrome is disfunction, so its shape and signal is normal.Except 1 Crohn disease, which showed a large mass, was misdiagnosed as lymphoma and no abnormality was found in 1 irritable bowel syndrome, the other diagnosis of MRI was correct.The sensitivity in diagnosing small intestinal disease was 100%, and the specificity was 83%.Conclusion MR enteroclysis with air infusion is a sensitive method in diagnosing the small bowel disease, especially in Crohn disease and tumor.It can clearly display the mural thickening and the extraluminal inflammatory mass.