title: Small bowel hydro-MR imaging for optimized ileocecal distension in Crohn's disease: should an additional rectal enema filling be performed?
abstract: OBJECTIVE
  To assess the impact of an additional rectal enema filling in small bowel hydro-MRI in patients with Crohn's disease.
  
  
  METHODS
  A total of 40 patients with known Crohn's disease were analyzed retrospectively: 20 patients only ingested an oral contrast agent (group A), the other 20 subjects obtained an additional rectal water enema (group B). For small bowel distension, a solution containing 0.2% locust bean gum (LBG) and 2.5% mannitol was used. In all patients, a breathhold contrast-enhanced T1w three-dimensional volumetric interpolated breathhold examination (VIBE) sequence was acquired. Comparative analysis was based on image quality and bowel distension as well as signal-to-noise ratio (SNR) measurements. MR findings were compared with those of conventional colonoscopy, as available (N = 25).
  
  
  RESULTS
  The terminal ileum and rectum showed a significantly higher distension following the rectal administration of water. Furthermore, fewer artifacts were seen within group B. This resulted in a higher reader confidence for the diagnosis of bowel disease, not only in the colon, but also in the ileocecal region. Diagnostic accuracy in diagnosing inflammation of the terminal ileum was 100% in group B; in the nonenema group there were three false-negative diagnoses of terminal ileitis.
  
  
  CONCLUSIONS
  Our data show that the additional administration of a rectal enema is useful in small bowel MRI for the visualization of the terminal ileum. The additional time needed for the enema administration was minimal, and small and large bowel pathologies could be diagnosed with high accuracy. Thus, we suggest that a rectal enema in small bowel MR imaging be considered.
authors.affiliation: Departmens of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany. waleed.ajaj@uni-essen.de
authors.forename: Waleed
authors.initials: W
authors.lastname: Ajaj
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Lauenstein
authors.forename: Jost
authors.initials: J
authors.lastname: Langhorst
authors.forename: Christiane
authors.initials: C
authors.lastname: Kuehle
authors.forename: Mathias
authors.initials: M
authors.lastname: Goyen
authors.forename: Thomas
authors.initials: T
authors.lastname: Zoepf
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Ruehm
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Jorg F
authors.initials: JF
authors.lastname: Debatin
authors.forename: Susanne C
authors.initials: SC
authors.lastname: Goehde
mesh_terms: D000328:Adult; D002432:Cecum / Q000473:pathology*; D003424:Crohn Disease / Q000175:diagnosis*; D004733:Enema; D005260:Female; D005685:Galactans; D006801:Humans; D007082:Ileum / Q000473:pathology*; D007420:Intestine, Large / Q000473:pathology*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008351:Mannans; D008353:Mannitol; D008875:Middle Aged; D053149:Plant Gums; D011134:Polysaccharides; D012189:Retrospective Studies
chemical_list: D005685:Galactans; D008351:Mannans; D053149:Plant Gums; D011134:Polysaccharides; D008353:Mannitol; C017471:locust bean gum