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Small bowel MRI in adult patients: not just Crohn's disease-a tutorial
Giedre Kavaliauskiene1, Manon L W Ziech, C Yung Nio
1Department of Radiology, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands, giedre.kavaliauskiene@gmail.com.
Objectives:
To provide an overview of less well-known small bowel and mesenteric diseases found at small bowel magnetic resonance (MR) enterography/enteroclysis and to review the imaging findings. MR enterography and enteroclysis are important techniques for evaluation of small bowel diseases. In most centres these techniques are primarily used in Crohn's disease, and most radiologists are familiar with these MRI findings. However, the knowledge of findings in other diseases is often sparse, including diseases that may cause similar clinical symptoms to those of Crohn's disease.
Methods:
We present a spectrum of less common and less well-known bowel and mesenteric diseases (e.g. internal hernia, intussusception, neuroendocrine tumour) from our small bowel MR database of over 2,000 cases.
Results:
These diseases can be found in patients referred for bowel obstruction, abdominal pain or rectal blood loss. Further, in patients with (or suspected to have) Crohn's disease, some of these diseases (e.g. neuroendocrine tumour, familial Mediterranean fever) may mislead radiologists to erroneously diagnose active Crohn's disease.
Conclusion:
Radiologists should be familiar with diseases affecting the small bowel other than Crohn's disease, including diseases that may mimic Crohn's disease.
Insights
Magnetic resonance (MR) enterography is key for small bowel evaluation. Radiologists must recognize less common conditions beyond Crohn's disease that can mimic it on MR imaging.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Small bowel magnetic resonance (MR) enterography/enteroclysis is vital for diagnosing small bowel diseases.
- While commonly used for Crohn's disease, radiologists often have limited knowledge of other conditions evaluated by these techniques.
- Many small bowel and mesenteric diseases present with symptoms similar to Crohn's disease, complicating diagnosis.
Purpose of the Study:
- To overview less common small bowel and mesenteric diseases detected via MR enterography/enteroclysis.
- To review the characteristic imaging findings of these conditions.
- To enhance radiologists' awareness of differential diagnoses for small bowel pathologies.
Main Methods:
- Review of over 2,000 small bowel MR enterography/enteroclysis cases.
- Inclusion of less common and less well-known bowel and mesenteric diseases.
- Focus on conditions like internal hernia, intussusception, and neuroendocrine tumors.
Main Results:
- Identified various less common diseases in patients presenting with bowel obstruction, abdominal pain, or rectal blood loss.
- Some conditions, such as neuroendocrine tumors and familial Mediterranean fever, can be misdiagnosed as active Crohn's disease.
- These findings highlight the importance of a broad differential diagnosis in small bowel MR imaging.
Conclusions:
- Radiologists need comprehensive knowledge of small bowel diseases beyond Crohn's disease.
- Familiarity with conditions mimicking Crohn's disease is crucial for accurate MR diagnosis.
- MR enterography/enteroclysis can reveal a spectrum of pathologies requiring expert interpretation.
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