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MR Colonography in Patients with Incomplete Conventional Colonoscopy¹

¹ From the Departments of Diagnostic and Interventional Radiology (W.A., T.C.L., S.G.R., J.F.D., S.C.G.) and Gastroenterology and Hepatology (G.P., G.H.), University Hospital Essen, Hufelandstrasse 55, 45122 Essen, Germany. Received December 11, 2003; revision requested February 19, 2004; revision received April 2; accepted May 17. Address correspondence to W.A. (e-mail: waleed.ajaj@uni-essen.de).

View larger version (155K): [in a new window]   Figure 1a. Dark-lumen MR colonographic images in a 51-year-old man with history of colorectal carcinoma and end-to-end anastomosis. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) shows high-grade stenosis (white box), which was histologically verified as being caused by an infiltrative recurrent carcinoma, that could not be passed with the endoscope. (b) MR colonography also failed, because there was not sufficient water passing through the stenosis to permit adequate distention of prestenotic segments.

View larger version (145K): [in a new window]   Figure 1b. Dark-lumen MR colonographic images in a 51-year-old man with history of colorectal carcinoma and end-to-end anastomosis. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) shows high-grade stenosis (white box), which was histologically verified as being caused by an infiltrative recurrent carcinoma, that could not be passed with the endoscope. (b) MR colonography also failed, because there was not sufficient water passing through the stenosis to permit adequate distention of prestenotic segments.

View larger version (149K): [in a new window]   Figure 2. Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 44-year-old woman undergoing dark-lumen MR colonography, with abdominal pain and incomplete colonoscopy because of elongation of sigmoid colon. Colonic elongation did not prove to be a hindrance for MR colonography. All segments inaccessible with conventional colonoscopy in group B patients were accurately assessed with MR colonography.

View larger version (151K): [in a new window]   Figure 3. Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 37-year-old woman with ulcerative colitis and inflammatory occlusion in the descending colon. Conventional colonoscopy was incomplete because of high-grade stenosis. MR colonography permitted assessment of segments proximal to the site of stenosis and revealed inflammatory changes affecting the transverse colon, as evidenced by loss of colonic folds and increased contrast agent uptake in the colonic wall.

View larger version (148K): [in a new window]   Figure 4a. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 60-year-old woman undergoing dark-lumen MR colonography, with stenotic carcinoma in the sigmoid colon (arrow) and incomplete colonoscopy. (b) MR colonographic image reveals metachronous carcinoma (arrow) in a prestenotic segment at the right colonic flexure.

View larger version (154K): [in a new window]   Figure 4b. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 60-year-old woman undergoing dark-lumen MR colonography, with stenotic carcinoma in the sigmoid colon (arrow) and incomplete colonoscopy. (b) MR colonographic image reveals metachronous carcinoma (arrow) in a prestenotic segment at the right colonic flexure.

View larger version (150K): [in a new window]   Figure 5a. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 62-year-old woman with stenotic sigmoid diverticulitis (white box, arrow in b) and incomplete colonoscopy. (b) MR colonography-based assessment of the prestenotic segments revealed a small polyp (arrowhead).

View larger version (143K): [in a new window]   Figure 5b. (a) Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 62-year-old woman with stenotic sigmoid diverticulitis (white box, arrow in b) and incomplete colonoscopy. (b) MR colonography-based assessment of the prestenotic segments revealed a small polyp (arrowhead).

View larger version (163K): [in a new window]   Figure 6. Coronal T1-weighted 3D source image obtained with volumetric interpolated breath-hold examination (3.1/1.1, 12° flip angle) in a 56-year-old man with incomplete colonoscopy owing to elongation of sigmoid colon depicts a small polyp (arrow) with contrast agent uptake in the transverse colon at the right colonic flexure.

View larger version (117K): [in a new window]   Figure 7a. (a) MR colonographic image in a 63-year-old woman with incomplete colonoscopy because of high-grade stenotic carcinoma (arrow) in the sigmoid colon. (b) Transverse reformation of T1-weighted 3D volumetric interpolated breath-hold examination sequence (3.1/1.1, 12° flip angle). MR colonography helped exclude relevant disease in prestenotic colonic segments but did demonstrate multiple hepatic metastases.

View larger version (126K): [in a new window]   Figure 7b. (a) MR colonographic image in a 63-year-old woman with incomplete colonoscopy because of high-grade stenotic carcinoma (arrow) in the sigmoid colon. (b) Transverse reformation of T1-weighted 3D volumetric interpolated breath-hold examination sequence (3.1/1.1, 12° flip angle). MR colonography helped exclude relevant disease in prestenotic colonic segments but did demonstrate multiple hepatic metastases.