Parakkal Deepak, Daniel R Ludwig, Jeff L Fidler, Flavius F Guglielmo, David H Bruining
{"title":"Medical and Endoscopic Management of Crohn Disease.","authors":"Parakkal Deepak, Daniel R Ludwig, Jeff L Fidler, Flavius F Guglielmo, David H Bruining","doi":"10.1097/RMR.0000000000000267","DOIUrl":"10.1097/RMR.0000000000000267","url":null,"abstract":"<p><strong>Abstract: </strong>In this review, through a series of questions and answers, we explore the current approach to classifying patients with Crohn disease into low-risk (mild-moderate) and high-risk (moderate-severe) categories with the recommended treatment approaches per guidelines from the International Organization for the Study of Inflammatory Bowel Diseases, American Gastroenterological Association, the American College of Gastroenterology, and the European Crohn's and Colitis Organization detailed here. The development pipeline of potential therapies is also summarized. We also review key information from magnetic resonance enterography and pelvis imaging studies that the abdominal radiologist can communicate to a multidisciplinary treatment team that includes gastroenterologists and colorectal surgeons, with a goal of achieving optimal patient outcomes. Lastly, endoscopic and radiological treatment targets in a treat-to-target approach in Crohn disease are explored.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"30 1","pages":"43-61"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Manjil Chatterji, Jeff L Fidler, Stuart A Taylor, Sudha A Anupindi, Benjamin M Yeh, Flavius F Guglielmo
{"title":"State of the Art MR Enterography Technique.","authors":"Manjil Chatterji, Jeff L Fidler, Stuart A Taylor, Sudha A Anupindi, Benjamin M Yeh, Flavius F Guglielmo","doi":"10.1097/RMR.0000000000000263","DOIUrl":"10.1097/RMR.0000000000000263","url":null,"abstract":"<p><strong>Abstract: </strong>Magnetic resonance enterography (MRE) is a well-established imaging technique that is commonly used for evaluating a variety of bowel diseases, most commonly inflammatory bowel disease which is increasing in prevalence. Inflammatory bowel disease is composed of 2 related, but distinct disease entities: Crohn disease (CD) and ulcerative colitis. In ulcerative colitis, inflammation is generally limited to the mucosa and invariably involves the rectum, and often the more proximal colon. CD is typified by transmural inflammation with skip lesions occurring anywhere from the mouth to anus, but characteristically involves the terminal ileum. The transmural involvement of CD may lead to debilitating ulceration and, ultimately, development of sinus tracts, which can be associated with abscesses and fistulae as extraenteric manifestations of the disease. Because much of the small bowel and extraenteric disease cannot be adequately assessed with conventional endoscopy, imaging plays a crucial role in initial diagnosis and follow-up. MRE does not use ionizing radiation which is important for these patients, many of which present earlier in life and may require multiple imaging examinations. In this article, we review the clinical indications, patient preparation, and optimal technique for MRE. We also discuss the role and proper selection of intravenous gadolinium-based contrast material, oral contrast material, and antiperistaltic agents, including pediatric considerations. Finally, we review the recommended and optional pulse sequence selection, including discussion of a \"time-efficient\" protocol, reviewing their utility, advantages, and limitations. Our hope is to aid the radiologist seeking to develop a robust MRE imaging program for the evaluation of bowel disease.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"30 1","pages":"3-11"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Octavia Bane, Michael S Gee, Alex Menys, Jonathan R Dillman, Bachir Taouli
{"title":"Emerging Imaging Biomarkers in Crohn Disease.","authors":"Octavia Bane, Michael S Gee, Alex Menys, Jonathan R Dillman, Bachir Taouli","doi":"10.1097/RMR.0000000000000264","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000264","url":null,"abstract":"<p><strong>Abstract: </strong>In this review article, we present the latest developments in quantitative imaging biomarkers based on magnetic resonance imaging (MRI), applied to the diagnosis, assessment of response to therapy, and assessment of prognosis of Crohn disease. We also discuss the biomarkers' limitations and future prospects. We performed a literature search of clinical and translational research in Crohn disease using diffusion-weighted MRI (DWI-MRI), dynamic contrast-enhanced MRI (DCE-MRI), motility MRI, and magnetization transfer MRI, as well as emerging topics such as T1 mapping, radiomics, and artificial intelligence. These techniques are integrated in and combined with qualitative image assessment of magnetic resonance enterography (MRE) examinations. Quantitative MRI biomarkers add value to MRE qualitative assessment, achieving substantial diagnostic performance (area under receiver-operating curve = 0.8-0.95). The studies reviewed show that the combination of multiple MRI sequences in a multiparametric quantitative fashion provides rich information that may help for better diagnosis, assessment of severity, prognostication, and assessment of response to biological treatment. However, the addition of quantitative sequences to MRE examinations has potential drawbacks, including increased scan time and the need for further validation before being used in therapeutic drug trials as well as the clinic.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"30 1","pages":"31-41"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cynthia S Santillan, Chenchan Huang, Samuel Eisenstein, Mahmoud M Al-Hawary
{"title":"MRI of Perianal Crohn Disease: Technique and Interpretation.","authors":"Cynthia S Santillan, Chenchan Huang, Samuel Eisenstein, Mahmoud M Al-Hawary","doi":"10.1097/RMR.0000000000000268","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000268","url":null,"abstract":"<p><strong>Abstract: </strong>Magnetic resonance imaging (MRI) has emerged as the imaging method of choice for evaluation of perianal fistulizing disease. As treatment of Crohn disease and associated perianal fistulas has evolved to include a combination of systemic treatments and surgical interventions, perianal MRI provides critical information to guide treatment selection and timing. Radiologists need to be familiar with the normal regional anatomy to accurately describe perianal fistulas and any associated complications which can then be used to classify fistulas based on several available classification systems. Following treatment, MRI can provide information that suggests treatment success or failure. We propose a perianal fistula reporting template that includes the necessary information to convey fistula complexity, guide treatment, and evaluate treatment response. This review article will also discuss the postoperative appearance of many treatments currently used for management of perianal fistulizing disease and some associated complications.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"30 1","pages":"63-76"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph R Grajo, Chenchan Huang, Jonathan R Dillman, Michael S Gee, Tracy A Jaffe, Jorge A Soto, Mark E Baker
{"title":"MR Enterography of Complicated Crohn Disease: Stricturing and Penetrating Disease.","authors":"Joseph R Grajo, Chenchan Huang, Jonathan R Dillman, Michael S Gee, Tracy A Jaffe, Jorge A Soto, Mark E Baker","doi":"10.1097/RMR.0000000000000266","DOIUrl":"10.1097/RMR.0000000000000266","url":null,"abstract":"<p><strong>Abstract: </strong>Stricturing and penetrating disease are complications of Crohn disease (CD) that significantly affect patient outcomes. Careful evaluation for such complications is critical to the interpretation of magnetic resonance enterography. This manuscript outlines the key findings related to stricturing and penetrating CD and discusses current understanding of the pathophysiology and prognosis of complicated CD based on the literature.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"30 1","pages":"23-30"},"PeriodicalIF":0.0,"publicationDate":"2021-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25322435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preface \"MRI in the ER\".","authors":"Felipe Munera","doi":"10.1097/RMR.0000000000000262","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000262","url":null,"abstract":"D iagnostic imaging now plays an essential role in the care of emergency patients. The catalyst for this reliance on imaging studies has mainly been the exponential increase in computed tomography (CT) utilization over the last couple of decades. CT remains the ‘‘workhorse\" imaging modality in the emergency room (ER) as it is familiar to all radiologists. It is an accurate modality that is fast, noninvasive, readily available, easily accessible, and surveys broadly for disease or injury. CT in emergency patients provides many advantages such as increase in the physician’s level of certainty for diagnosing or ruling out pathology and more timely surgical intervention when necessary. The use of CT is also efficient, improving turnaround times and helping to reduce hospital admissions. However, concerns for indiscriminate radiation exposure have made even more important the routine reliance on evidence guidelines for appropriate CT utilization in the ER and the use of alternative imaging modalities when pertinent. The rapid evolution of magnetic resonance (MR) scanners with the increasing availability of rapid sequences easier to use in challenging emergencies with acutely ill patients potentially having a decreased breath-hold capability, neurological impairment, or other difficulties in cooperating with lengthy MR examinations and the obvious advantage of lack of","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"29 6","pages":"273"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38674940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel R Ludwig, Constantine A Raptis, Jordi Broncano, Sanjeev Bhalla, Antonio Luna
{"title":"Role of MRI in the Evaluation of Thoracoabdominal Emergencies.","authors":"Daniel R Ludwig, Constantine A Raptis, Jordi Broncano, Sanjeev Bhalla, Antonio Luna","doi":"10.1097/RMR.0000000000000252","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000252","url":null,"abstract":"<p><p>Thoracic and abdominal pathology are common in the emergency setting. Although computed tomography is preferred in many clinical situations, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have emerged as powerful techniques that often play a complementary role to computed tomography or may have a primary role in selected patient populations in which radiation is of specific concern or intravenous iodinated contrast is contraindicated. This review will highlight the role of MRI and MRA in the emergent imaging of thoracoabdominal pathology, specifically covering acute aortic pathology (acute aortic syndrome, aortic aneurysm, and aortitis), pulmonary embolism, gastrointestinal conditions such as appendicitis and Crohn disease, pancreatic and hepatobiliary disease (pancreatitis, choledocholithiasis, cholecystitis, and liver abscess), and genitourinary pathology (urolithiasis and pyelonephritis). In each section, we will highlight the specific role for MRI, discuss basic imaging protocols, and illustrate the MRI features of commonly encountered thoracoabdominal pathology.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"29 6","pages":"355-370"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38324730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aaron Winn, Adam Martin, Ivan Castellon, Allen Sanchez, Efrat Saraf Lavi, Felipe Munera, Diego Nunez
{"title":"Spine MRI: A Review of Commonly Encountered Emergent Conditions.","authors":"Aaron Winn, Adam Martin, Ivan Castellon, Allen Sanchez, Efrat Saraf Lavi, Felipe Munera, Diego Nunez","doi":"10.1097/RMR.0000000000000261","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000261","url":null,"abstract":"Over the last 2 decades, the proliferation of magnetic resonance imaging (MRI) availability and continuous improvements in acquisition speeds have led to significantly increased MRI utilization across the health care system, and MRI studies are increasingly ordered in the emergent setting. Depending on the clinical presentation, MRI can yield vital diagnostic information not detectable with other imaging modalities. The aim of this text is to report on the up-to-date indications for MRI of the spine in the ED, and review the various MRI appearances of commonly encountered acute spine pathology, including traumatic injuries, acute non traumatic myelopathy, infection, neoplasia, degenerative disc disease, and postoperative complications. Imaging review will focus on the aspects of the disease process that are not readily resolved with other modalities.","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"29 6","pages":"291-320"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38324726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Martin, Aaron Winn, Allen Sanchez, Ivan Castellon, Felipe Munera, Diego Nunez
{"title":"MRI of Emergent Intracranial Infections and Their Complications.","authors":"Adam Martin, Aaron Winn, Allen Sanchez, Ivan Castellon, Felipe Munera, Diego Nunez","doi":"10.1097/RMR.0000000000000259","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000259","url":null,"abstract":"<p><p>Acute intracranial infections of the central nervous system and skull base are uncommon but time sensitive diagnoses that may present to the emergency department. As symptoms are frequently nonspecific or lack typical features of an infectious process, a high index of suspicion is required to confidently make the diagnosis, and imaging may not only serve as the first clue to an intracranial infection, but is often necessary to completely characterize the disease process and exclude any confounding conditions. Although computed tomography is typically the initial imaging modality for many of these patients, magnetic resonance imaging offers greater sensitivity and specificity in diagnosing intracranial infections, characterizing the full extent of infection, and identifying potential complications. The aim of this article is to serve as a review of the typical and most important imaging manifestations of these infections that can be encountered in the emergent setting.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"29 6","pages":"275-289"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38674941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph H Huntley, Samuel R Huntley, Dylan N Greif, Danielle C Marshall, Sohil Desai, Jose Rodriguez, Jean Jose
{"title":"Use of Magnetic Resonance Imaging for Orthopedic Trauma and Infection in the Emergency Department.","authors":"Joseph H Huntley, Samuel R Huntley, Dylan N Greif, Danielle C Marshall, Sohil Desai, Jose Rodriguez, Jean Jose","doi":"10.1097/RMR.0000000000000256","DOIUrl":"https://doi.org/10.1097/RMR.0000000000000256","url":null,"abstract":"<p><p>Conditions affecting the musculoskeletal system constitute a significant portion of medical emergencies in the United States, with traumatic injury and infection being two of the most common etiologies. Although physical examination and plain radiographs are often sufficient to guide diagnosis and treatment, there are myriad traumatic and infectious pathologies that are commonly missed or simply not detectable on plain radiographs. Advanced imaging is subsequently warranted for additional workup.Magnetic resonance imaging (MRI) has become an increasingly used imaging modality for musculoskeletal complaints in the emergency department due to its superior visualization of soft tissues, focal edematous changes, and occult osseous insults often not visible on plain radiographs. Although multiple studies have evaluated its utility in the workup of emergency musculoskeletal complaints, there remains a dearth of literature examining the use of MRI for certain occult diagnoses.Radiologists, emergency clinicians, and orthopedic surgeons must be knowledgeable of the indications for MRI in the emergency setting, as delayed diagnosis may contribute to increased morbidity and possibly mortality. This review summarizes the use of MRI in diagnoses relating to trauma or infection among patients presenting to the emergency department with a musculoskeletal complaint.</p>","PeriodicalId":39381,"journal":{"name":"Topics in Magnetic Resonance Imaging","volume":"29 6","pages":"331-346"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38324729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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