Pediatric MR Enterography

Pediatric MR enterography evaluates small bowel distended with oral contrast medium typically polyethylene glycol or mannitol using MR imaging without ionizing radiation. The technique is preferred over CT enterography in children because of radiation safety concerns particularly given the cumulative dose during repeated examinations in chronic conditions like inflammatory bowel disease.

Standard protocol begins with patient drinking oral contrast over forty five to sixty minutes before scanning to distend small bowel adequately. Imaging includes T2 weighted single shot fast spin echo sequences for bowel wall and lumen evaluation balanced steady state free precession for motion robust imaging diffusion weighted imaging for inflammation detection and post contrast T1 weighted imaging for vascular and inflammatory enhancement assessment.

Findings in Crohn disease include bowel wall thickening over three millimeters mucosal hyperenhancement edema mesenteric inflammation lymphadenopathy fibrofatty proliferation and complications including strictures fistulas and abscesses. The technique provides global small bowel assessment in single examination superior to capsule endoscopy or upper gastrointestinal series with small bowel follow through. Sedation may be required in young children but most adolescents tolerate the examination without sedation. Annual or biennial monitoring guides treatment decisions in established inflammatory bowel disease.