MR ENTEROGRAPHY - TIDE OVER THE BOWEL MOTION ARTIFACTS

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MRI ENTEROGRAPHY- TIME THE BUSCOPAN WITH IV CONTRAST & PLAN EARLY

    
Figure: Crohn's involvement of the IC Junction with avid contrast enhancement and diffusion restriction

  PROTOCOL:

   Negative oral contrast (3 % mannitol 1 litre, followed by 500 ml top up by water) over 30-40 minutes. 

   Patient should be taken on the MRI table immediately as soon as the top up by     oral water is completed. 

   Sequences typically used:

   1. T2 W HASTE/SSFSE - axial and coronal

   2. T2 W Cine - coronal

   3. DWI b = 800

   4. Pre contrast 3D T1 FS VIBE/LAVA coronal and axial

   5. Post contrast /dynamic - Coronal  3D T1 FS VIBE/LAVA - 4 set

   6. Post contrast T1 W FS 2D axial and coronal


 Problems: 

1. Jejunum empties fast

2. Significant bowel motion artifacts despite giving buscopan


Tackling the problems:

1. Take i.v line before the oral contrast is given

2. Adhere to the timings, start oral only when you are sure of taking the pt on time

3. Quick HASTE -SSFSE screening in axial and coronal

     Cine in coronal (don't spend too much time)

     Pre contrast T1 W  FS 3D VIBE / LAVA - axial and coronal

     Buscopan-i.v 20 mg

     Do post contrast 3D in coronal - dynamic - 4 set

     Do post contrast 3 D in axial - one set

     Do T2 W FS in axial

     Do DWI b = 800 in axial

     Do delayed post contrast T1 W FS 2D in axial & coronal

    

    Alternative planning:

    After scout is done: do cine followed by 20 mg. buscopan i.m

    Do all the pre contrast sequences, including the T2W and DWI

    Give buscopan i.v and do the contrast

    

     

  



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