Comprehensive Magnetic Resonance Imaging of the Small and Large Bowel Using Intraluminal Dual Contrast Technique With Iron Oxide Solution and Water in Magnetic Resonance Enteroclysis

Abstract

The objective of this study was to improve delineation of small and large bowel (SB, LB) anatomy and pathology with postoperative or complex multisegmental inflammatory changes using dual-contrast-technique (DCT) for magnetic resonance enteroclysis (MRE) with luminal contrast media of opposed signal characteristics. Sixty patients underwent MRE with iron oxide-based negative contrast in the SB. Thirty patients received additional rectal instillation of water for positive contrast (DCT). Two observers evaluated the degree of distention and the ease of identification of bowel anatomy and pathologies (none n = 22, stenosis n = 16, abscess n = 4, fistulae n = 5, postoperative changes and adhesions n = 13) using a 4-point scale. Mann-Whitney U-test and kappa statistics were applied. LB and the terminal ileum were significantly better distended and identified with DCT (P ≤ 0.0001; P = 0.034). Interobserver agreement improved with DCT for all pathologies except for “prestenotic dilatation.” Comprehensive MR imaging of SB and LB with DCT improves the identification of modified anatomy and most pathologies in inflammatory and postsurgical bowel.