Simon James Dupre MBBS, Presenter: Nothing to Disclose

Paul Tesar, Abstract Co-Author: Nothing to Disclose

Graham Radford-Smith, Abstract Co-Author: Nothing to Disclose

Ray Buckley, Abstract Co-Author: Nothing to Disclose

Christine McHenery, Abstract Co-Author: Nothing to Disclose

Hyun Soo Ko MD, Abstract Co-Author: Nothing to Disclose

To compare patient tolerance, image quality and luminal distension in patients with inflammatory bowel disease who received either MR enteroclysis (via nasojejunal tube) or MR enterography (following oral contrast).

Adult patients with inflammatory bowel disease referred by a gastroenterologist for bowel MRI were prospectively randomised over a 6 month period to either MR enteroclysis (1-1.5L Methylcellulose administered via nasojejunal tube), or MR enterography (1-1.5L oral Metamucil™ psyllium husk). Written informed consent was obtained. Patients completed two questionnaires assessing overall procedure-tolerance and symptoms such as discomfort, nausea, vomiting, bloating and diarrhea. The first questionnaire was completed immediately following MR; the second was completed 6-12 hrs after the exam. Two radiologists experienced in gastrointestinal MRI read the de-identified MR images in consensus, assessing overall image-quality (Likert scale: 1-5) and mucosal, mural and extramural disease. Luminal distension was estimated for 10 segments of bowel from duodenum to rectum (Likert scale: 1-4).

77 Patients formed the study group (MR enteroclysis n=35; MR enterography n=42). Fisher's exact test was used to analyse patient-reported symptoms, which did not differ significantly between both groups (p>0.05). However, in the enteroclysis group, significantly fewer patients would consent to repeat procedure, and more would prefer an alternate procedure (p0.05). In the enterography group, the jejunum and proximal ileum had significantly greater distension (p0.05) was seen in distension of the duodenum, terminal ileum, cecum, ascending colon or transverse colon.

Patient tolerance with MR enterography was equal or better to that of MR enteroclysis on all measured attributes. No difference in image quality was seen between MR enterography and MR enteroclysis. MR enteroclysis achieved equal or significantly greater distension of large bowel segments compared to enterography, whereas MR enterography achieved equal or significantly greater distension of small bowel segments.

Given the superior patient tolerability, equal image quality and improved distension of small bowel with MR enterography compared to MR enteroclysis, MR enterography was implemented as routine protocol for small bowel imaging at our institution.

Dupre, S, Tesar, P, Radford-Smith, G, Buckley, R, McHenery, C, Ko, H, MRI of Inflammatory Bowel Disease: A Prospective Randomised Study Assessing Patient Tolerance, Image Quality, and Luminal Distension of MR Enteroclysis vs MR Enterography.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005928.html