Brief Article
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World J Gastroenterol. Feb 28, 2013; 19(8): 1256-1263
Published online Feb 28, 2013. doi: 10.3748/wjg.v19.i8.1256
Magnetic resonance imaging: Is there a role in clinical management for acute ischemic colitis?
Maria Antonietta Mazzei, Susanna Guerrini, Nevada Cioffi Squitieri, Giusi Imbriaco, Raffaele Chieca, Serenella Civitelli, Vinno Savelli, Francesco Giuseppe Mazzei, Luca Volterrani
Maria Antonietta Mazzei, Susanna Guerrini, Nevada Cioffi Squitieri, Giusi Imbriaco, Luca Volterrani, Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, 53100 Siena, Italy
Raffaele Chieca, Oncologic Department, UOC Gastroenterology and Digestive Endoscopy, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Serenella Civitelli, Division of Surgery, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
Vinno Savelli, Department of Surgery and Bioengineering, Section of Surgery, University of Siena, 53100 Siena, Italy
Francesco Giuseppe Mazzei, Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, 53100 Siena, Italy
Author contributions: Mazzei MA, Guerrini S, Cioffi Squitieri N, Imbriaco G, Chieca R, Civitelli S, Savelli V, and Mazzei FG substantial contributions to conception and design acquisition of data, analysis and interpretation of data; Mazzei MA and Volterrani L contributions to drafting the article, revising it critically for important intellectual content and final approval of the version to be published.
Correspondence to: Maria Antonietta Mazzei, MD, Assistant Professor of Radiology, Department of Human Pathology and Oncology, Section of Radiological Sciences, University of Siena, Viale Bracci 10, 53100 Siena, Italy. mariaantonietta.mazzei@unisi.it
Telephone: +39-577-585700 Fax: +39-577-44496
Received: August 9, 2012
Revised: November 26, 2012
Accepted: December 15, 2012
Published online: February 28, 2013
Abstract

AIM: To validate the utility of magnetic resonance imaging (MRI) for the clinical management of acute ischemic colitis (IC).

METHODS: This is a magnetic resonance (MR) prospective evaluation of 7 patients who were proved to have acute IC on the basis of clinical, endoscopic and computed tomography (CT) findings and who were imaged in our institution between February 2011 and July 2012. The mean age of the patients was 72.28 years. Abdominal CTs were obtained using a 64-detector row configuration for all patients with un-enhanced and contrast-enhanced scans, in the late arterial phase (start delay 45-50 s) and in the portal venous phase (start delay 70-80 s). The MR examinations were performed using a 1.5T superconducting magnet, using Fast Imaging Employing Steady State Acquisition and T2-weighted fast-recovery fast-spin echo sequences in axial and coronal plane. CT and MRI examinations were analysed for the presence of colonic abnormalities and associated findings.

RESULTS: Segmental involvement was seen in 6 patients (85.71%), with a mean length of involvement of 412 mm (range 145.5-1000 mm). Wall thickness varied between 6 mm and 17.5 mm (mean 10.52 mm) upon CT examinations and from 5 to 15 mm (mean 8.8 mm) upon MR examinations. The MRI appearance of the colonic wall varied over the time: Type I appearance with a 3 layer sandwich sign was seen in 5 out of 12 examinations (41.66%), patients underwent MR within a mean of 36 h (ranging from 1 to 54 h) after the CT examination. Type II and III appearance with a 2 layer sign, was seen in 4 examinations (33.33%), patients underwent MR within a mean of 420.5 h (ranging from 121 to 720 h) after the CT examination. In the remaining three MRI examinations, performed within a mean of 410 h (ranging from 99.5 to 720 h) the colonic wall appeared normal.

CONCLUSION: MRI, only using precontrast images, may be used as a substitute for invasive procedures in diagnosis and follow-up of acute IC.

Keywords: Ischemic colitis, Magnetic resonance imaging, Medical management, Colon, Computed tomography