MRI OF ENTEROGRAPHY (SMALL BOWEL)
INDICATION
- Low-grade small-bowel obstruction
- Small-bowel masses
- Crohns disease
PREPARATION
- Blood for Serum Creatinine.
- FNAC/Biopsy Test Reports.
- Old Documents.
- Operation Note.
PATIENT PREPARATION
- A satisfactory written consent form must be taken from the patient before entering the scanner room Ask the patient to remove all metal object including keys, coins, wallet, any cards with magnetic strips, jewellery, hearing aid and hairpins
- Ask the patient to undress and change into a hospital gown
- Instruct the patient to hold their breath for the breath hold scans (its better to coach the patient two to three times before starting the scan)
- Contrast and buscopan injection risk and benefits must be explained to the patient before the scan Gadolinium should only be given to the patient if GFR is >30
- An intravenous line must be placed with extension tubing extending out of the magnetic bore Claustrophobic patients may be accompanied into the scanner room e.g. by staff member or relative with proper safety screening
- Offer headphones for communicating with the patient and ear protection
- Explain the procedure to the patient and answer questions
- Patient should fast for at least six hours Note down the weight of the patient
PATIENT PREPARATION
- A satisfactory written consent form must be taken from the patient before entering the scanner room Ask the patient to remove all metal object including keys, coins, wallet, any cards with magnetic strips, jewellery, hearing aid and hairpins
- Ask the patient to undress and change into a hospital gown
- Instruct the patient to hold their breath for the breath hold scans (its better to coach the patient two to three times before starting the scan)
- Contrast and buscopan injection risk and benefits must be explained to the patient before the scan Gadolinium should only be given to the patient if GFR is >30
- An intravenous line must be placed with extension tubing extending out of the magnetic bore Claustrophobic patients may be accompanied into the scanner room e.g. by staff member or relative with proper safety screening
- Offer headphones for communicating with the patient and ear protection
- Explain the procedure to the patient and answer questions
- Patient should fast for at least six hours Note down the weight of the patient
PROTOCOL
ORAL CONTRAST
- The purpose of using oral contrast agent is to produce high signal intensity in the bowel lumen on T2-weighted images and low signal intensity in the lumen on T1-weighted images.
- Low signal intensity in the lumen on T1 is important for the detection of mural enhancement on postcontrast T1-weighted images.
- Water alone will not provide adequate bowel distention for MR enterography.
- Water mixed with mannitol or sorbitol solution can provide better distention. Adding 5ml of Metoclopramide can significantly increase the rate of evacuation of water from the stomach.
- In our department we use the proportion below, 1200 ml water 300 ml mannitol 5 ml Metoclopramide We ask the patients to drink minimum volume of 1.2 l oral contrast, although some patients cannot comply.
- To allow distal transit, we employ a minimum delay of 30 minutes from the start of contrast ingestion to imaging.
PLANNING
Picture: MRI of Enterography Axial Planning.
Picture: MRI of Enterography Coronal Planning.
