title: Magnetic resonance imaging: is there a role in clinical management for acute ischemic colitis?
abstract: OBJECTIVE
  To validate the utility of magnetic resonance imaging (MRI) for the clinical management of acute ischemic colitis (IC).
  
  
  METHODS
  This is a magnetic resonance (MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical, endoscopic and computed tomography (CT) findings and who were imaged in our institution between February 2011 and July 2012. The mean age of the patients was 72.28 years. Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans, in the late arterial phase (start delay 45-50 s) and in the portal venous phase (start delay 70-80 s). The MR examinations were performed using a 1.5T superconducting magnet, using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane. CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings.
  
  
  RESULTS
  Segmental involvement was seen in 6 patients (85.71%), with a mean length of involvement of 412 mm (range 145.5-1000 mm). Wall thickness varied between 6 mm and 17.5 mm (mean 10.52 mm) upon CT examinations and from 5 to 15 mm (mean 8.8 mm) upon MR examinations. The MRI appearance of the colonic wall varied over the time: Type I appearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations (41.66%), patients underwent MR within a mean of 36 h (ranging from 1 to 54 h) after the CT examination. Type II and III appearance with a 2 layer sign, was seen in 4 examinations (33.33%), patients underwent MR within a mean of 420.5 h (ranging from 121 to 720 h) after the CT examination. In the remaining three MRI examinations, performed within a mean of 410 h (ranging from 99.5 to 720 h) the colonic wall appeared normal.
  
  
  CONCLUSIONS
  MRI, only using precontrast images, may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC.
authors.affiliation: Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, 53100 Siena, Italy. mariaantonietta.mazzei@unisi.it
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Mazzei
authors.forename: Susanna
authors.initials: S
authors.lastname: Guerrini
authors.forename: Nevada
authors.initials: N
authors.lastname: Cioffi Squitieri
authors.forename: Giusi
authors.initials: G
authors.lastname: Imbriaco
authors.forename: Raffaele
authors.initials: R
authors.lastname: Chieca
authors.forename: Serenella
authors.initials: S
authors.lastname: Civitelli
authors.forename: Vinno
authors.initials: V
authors.lastname: Savelli
authors.forename: Francesco Giuseppe
authors.initials: FG
authors.lastname: Mazzei
authors.forename: Luca
authors.initials: L
authors.lastname: Volterrani
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D017091:Colitis, Ischemic / Q000175:diagnosis* / Q000628:therapy*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
keywords: Colon; Computed tomography; Ischemic colitis; Magnetic resonance imaging; Medical management