MRI enterography protocol

Indications

This protocol is used to evaluate patients' with known or suspected Crohn's disease.

Preparation

• IV contrast: 1 mmol/kg gadopentetate dimeglumine at 2 cc/s

• Oral contrast: Have patient begin drinking the first 450 cc barium sulfate 0.1% 30 minutes prior to exam time. Give patient second 450 cc barium sulfate 0.1% 15 minutes prior to exam time. At exam time, give 450 cc water

• 2 L nasal oxygen

• Start IV with at least 24-gauge needle; connect to power injector

• Use 2-phased array coils to cover entire abdomen and pelvis

• Glucagon IV 0.5 mg

Exam sequence

1. (1) Axial True FISP BH – Cover entire abdomen and pelvis. Anatomic overview. Identify suspicious bowel segments.

2. (2) Coronal True FISP BH – Cover entire abdomen and pelvis. Anatomic overview. Identify suspicious bowel segments.

3. (3) Axial T2 single-shot fast-spin echo FS BH – Cover entire abdomen and pelvis. Identify T2-bright signal within or adjacent to bowel wall. Evaluate for perianal disease.

4. (4) Coronal T2 single-shot fast-spin echo FS BH – Cover entire abdomen and pelvis. Identify T2-bright signal within or adjacent to bowel wall.

5. (5) Coronal volume-interpolated gradient echo BH pre-contrast – Identify anything T1-bright which could be mistaken later for enhancement.

6. (6) Coronal volume-interpolated gradient echo BH post-contrast 35 seconds – Identify abnormal mucosal hyperenhancement implying acute Crohn’s disease.

7. (7) Axial volume-interpolated gradient echo BH post-contrast ~ 2 minutes – Cover entire abdomen and pelvis.

8. (8) Coronal volume-interpolated gradient echo BH post 3 minutes – Identify delayed enhancement which, in the absence of early enhancement, indicates chronic, fibrotic disease.