Search

MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (

Examination of intestines using methods of magnetic resonance (MR) enterography and MR enteroclysis is currently considered to be the best way to visualise diseases of the small intestine like Crohn’s disease, other inflammatory diseases of the small intestine, celiac disease, small intestine tumours, and cancers. They are both used in the initial diagnostics, assessment of the severity, as well as in monitoring of the course of the disease and possible complications. Both diagnostic methods require initial preparation of the patient by oral administration of a contrast agent. There are three types of oral contrast agents used in MR enterography and MR enteroclysis: positive, negative, and biphasic. In addition, an intravenous gadolinium contrast agent is administered during the study. MR enterography and MR enteroclysis allow accurate assessment of such structures as: the thickness of the intestinal wall, layering of the intestinal wall, narrowing, obstruction, gastrointestinal fistulas, gastrointestinal adipose tissue, encapsulated or free fluid in the abdomen, and lymph nodes. The undoubted advantages of these diagnostic methods include the lack of invasiveness, the possi-bility of obtaining multifaceted images, the possibility of assessing pathology not only within the intestine, but also in parenteral localisation, and the total absence of exposure of the patient to ionising radiation. The quality of the MR images obtained using both techniques depends largely on the correct preparation of the patient before the examination, in which the nurse participates to a large extent, leading the correct cooperation of the patient with the medical staff performing the MRI examination.

Die radiologische Diagnostik von Erkrankungen des Dunndarms wurde in den letzten beiden Jahrzehnten einem dramatischen Wandel unterzogen. Durch rasche Fortschritte mit neuen Behandlungsmethoden und einem zunehmend therapeutischen Fokus auf transmuralen Heilungsprozessen ist eine Gesamtabklarung des Gastrointestinaltrakts in den Mittelpunkt geruckt. Durch die Einfuhrung der Endoskopie hat die gastrointestinale Bildgebung mit der Magen-Darm-Passage bzw. dem Enteroklysma mit einer relativ hohen Strahlenbelastung nur bedingte Einsatzmoglichkeiten gezeigt. Die Entwicklung der Schnittbildverfahren ermoglichte eine deutlich breitere radiologische Abklarung abdomineller Erkrankungen. Durch schnelle Untersuchungstechniken sowie einen hohen Weichteilkontrast mit dem grosen Vorteil einer fehlenden Strahlenexposition hat die MRT des Gastrointestinaltrakts zunehmende Bedeutung gewonnen. Bei suffizienter Fullung des Darmlumens liegt ein groser Vorteil in der gleichzeitigen Abbildung samtlicher Darmwandschichten, der perienteralen Strukturen sowie assoziierter abdomineller Veranderungen. Neue MR-Sequenzen wie diffusionsgewichtete Sequenzen, dynamische Kontrastmittelsequenzen oder die MR-Fluoroskopie ermoglichen die Detektion morphologischer Veranderungen mit zusatzlicher Charakterisierung dieser Darmabschnitte sowie die Beurteilung funktioneller Pathologien mit dynamischer Information uber eine gestorte Darmmotilitat. Aktuelle Richtlinien europaischer radiologischer und gastroenterologischer Organisationen haben die Bedeutung der Schnittbildverfahren und insbesondere der MRT fur die Erstdiagnose und das Follow-up bei Patienten mit Morbus Crohn bestatigt. Durch die Moglichkeit der Beurteilung aller Darmwandschichten sowie dem Vorhandensein extramuraler Komplikationen hat die MRT einen signifikanten Einfluss auf das weitere therapeutische Vorgehen bei Patienten mit chronisch entzundlichen Darmerkrankungen. Insbesondere bei Patienten mit chronisch entzundlichen Darmerkrankungen sollte aus Grunden der Strahlenhygiene bei hoher diagnostischer Aussagekraft die MRT als MR-Enterographie oder MR-Enteroklysma die Methode der Wahl fur die Abklarung von Dunndarmpathologien darstellen. Mithilfe verschiedener MR-Sequenzen sind nicht nur die Detektion, sondern auch die Charakterisierung der gefundenen Veranderungen fur die weitere Behandlung der Patienten entscheidend.

Small-bowel surveillance with polypectomy of polyps ≥15 mm prevents complications in patients with Peutz-Jeghers syndrome (PJS). We aimed to compare magnetic resonance enteroclysis (MRE) and double balloon enteroscopy (DBE) for diagnostic yield of these polyps and for patient preference. PJS patients prospectively underwent MRE followed by proximal DBE within 20 weeks. Endoscopists were blinded to the MRE results. We compared number of polyps ≥15 mm detected by MRE and DBE. Patients' perceptions of both procedures were assessed using questionnaires. Fifteen PJS patients (67% males, median age 47 y) underwent both MRE and DBE. Polyps ≥15 mm were identified by MRE and/or DBE in 12/15 (80%) patients. There was no significant difference in the detection of polyps ≥15 mm (38 by MRE vs. 50 by DBE, P=0.37). Sensitivity for these polyps was 62% (38/61) for MRE and 82% (50/61) for DBE. Patients' perceived shame and burden did not differ significantly between MRE and DBE. Patients reported significantly more pain during preparation for MRE than for DBE (moderate vs. no pain, P=0.02), although perceived pain during the procedures was comparable (both mild, P=0.89). For future small-bowel surveillance 10/13 (77%) patients preferred DBE over MRE (P=0.09). Our results suggest that MRE and DBE have a comparable diagnostic yield of polyps ≥15 mm. However, DBE allows for direct intervention and was preferred over MRE by most patients in this series. Larger cohorts of PJS patients are needed to fully evaluate the diagnostic yield of DBE compared with other modalities

Background and Aim: We aimed to prospectively determine patient burden and patient preference for magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy in patients with suspected or known Crohn's disease (CD) or occult gastrointestinal bleeding (OGIB). Methods: Consecutive consenting patients with CD or OGIB underwent magnetic resonance enteroclysis, capsule endoscopy and balloon-assisted enteroscopy. Capsule endoscopy was only performed if magnetic resonance enteroclysis showed no high-grade small bowel stenosis. Patient preference and burden was evaluated by means of standardized questionnaires at five moments in time. Results: From January 2007 until March 2009, 76 patients were included (M/F 31/45; mean age 46.9 years; range 20.0-78.4 years): 38 patients with OGIB and 38 with suspected or known CD. Seventeen patients did not undergo capsule endoscopy because of high-grade stenosis. Ninety-five percent (344/363) of the questionnaires were suitable for evaluation. Capsule endoscopy was significantly favored over magnetic resonance enteroclysis and balloon-assisted enteroscopy with respect to bowel preparation, swallowing of the capsule (compared to insertion of the tube/scope), burden of the entire examination, duration and accordance with the pre-study information. Capsule endoscopy and magnetic resonance enteroclysis were significantly preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, and magnetic resonance enteroclysis was significantly preferred over balloon-assisted enteroscopy for bowel preparation, painfulness and burden of the entire examination. Balloon-assisted enteroscopy was significantly favored over magnetic resonance enteroclysis for insertion of the scope and procedure duration. Pre- and post-study the order of preference was capsule endoscopy, magnetic resonance enteroclysis and balloon-assisted enteroscopy. Conclusion: Capsule endoscopy was preferred to magnetic resonance enteroclysis and balloon-assisted enteroscopy; it also had the lowest burden. Magnetic resonance enteroclysis was preferred over balloon-assisted enteroscopy for clarity of explanation of the examination, bowel preparation, painfulness and burden of the entire examination, and balloon-assisted enteroscopy over magnetic resonance enteroclysis for scope insertion and study duration.

Background and study aims: New modalities are available for visualization of the small bowel in patients with possible obscure gastrointestinal bleeding (OGIB), but their performance requires further comparison. This study compared the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy in patients with OGIB, using balloon-assisted enteroscopy (BAE) as the reference standard. Patients and methods: Consecutive consenting patients who were referred for evaluation of OGIB were prospectively included. Patients underwent MRE followed by capsule endoscopy and BAE. Patients with high grade stenosis at MRE did not undergo capsule endoscopy. The reference standard was BAE findings in visualized small-bowel segments and expert panel consensus for segments not visualized during BAE. Results: Over a period of 26 months, 38 patients were included (20 female [53 %]; mean age 58 years, range 28-75 years). Four patients (11 %) did not undergo capsule endoscopy due to high grade small-bowel stenosis at MRE (n=3; 8%) or timing issues (n=1; 3%). Capsule endoscopy was non-diagnostic in one patient. The reference standard identified abnormal findings in 20 patients (53 %). MRE had sensitivity, specificity, and positive and negative likelihood ratios of 21%, 100%, infinity, and 0.79, respectively. The corresponding values for capsule endoscopy were 61%, 85%, 4.1, and 0.46. The reference standard and capsule endoscopy did not differ in percent positive findings (P=0.34), but MRE differed significantly from the reference BAE (P

In this prospective study, 32 patients with symptoms suggestive of small-bowel disease underwent conventional enteroclysis and magnetic resonance (MR) enteroclysis. Image quality, luminal distension, wall thickening, homogeneity of luminal opacification, the presence of artefacts and extraluminal changes were assessed. Small-bowel pathologies were subsequently proved surgically and by follow-up examinations in 19 (59.4%) of the patients. Abnormal findings were detected by MR enteroclysis in 11 of these 19 patients (57.9%). Normal findings on MR enteroclysis were found in eight of the 19 patients (42.1%) whereas conventional enteroclysis detected abnormal findings in these patients. Abdominal lesions outside the small bowel, comprised renal cysts, cholelithiasis, ovarian cysts and horseshoe kidney, and were detected by MR enteroclysis in two, one, four and one, respectively, of these normal patients but not by conventional enteroclysis. Excluding lesions outside of the small bowel, a higher rate of false-negative results and the missing of superficial lesions occurred with MR enteroclysis. It is, therefore, suggested that MR enteroclysis should not be used as a primary way of evaluating small-bowel disease and its use should be restricted to follow-up examinations of known disease.

Magnetic resonance imaging (MRI) of the small bowel has become widely accepted at centers dedicated to the diagnosis and treatment of inflammatory bowel disease, due to the method's diagnostic efficacy. MR enteroclysis is an imaging modality that combines the advantages of enteroclysis and multiplanar MR and allows the detection and the manifestations of small bowel diseases wherever they are located (intraluminal, intramural, or extramural). Magnetic resonance enteroclysis (MRE) is an emerging technique used for the detection and evaluation of small bowel neoplasms. This article illustrates the imaging appearances of small bowel tumors on MRI and the usefulness of MR enteroclysis in the diagnosis and categorization of these tumors, also discussing the role of MRE in comparison with other diagnostic modalities.

Background: Magnetic resonance enteroclysis (MRE) is suggested to become the preferred radiological method in small-bowel Crohn's disease (CD). However, the performance of inexperienced readers may influence the diagnostic value of the method and has not been previously investigated. Purpose: To compare readings of MRE in small-bowel CD performed by experienced and inexperienced readers before and after training. Material and Methods: One experienced radiologist (observer 1) and two trainees (observers 2 and 3) reviewed 60 MRE examinations. A second reading was performed after training. Bowel wall thickness (BWT), ulcers (BWU), stenosis (BWS), fistulas (FIS), and abscesses (ABS) were evaluated. A reference standard based on clinical records was established. Results: BWT in the terminal ileum was evaluated with high diagnostic performance (sensitivity: observer 1, 83%; observer 2, 72%; observer 3, 78%). Only BWU was diagnosed with a higher sensitivity by observer 1 (78% vs. 33% and 39%, respectively; P=0.02). False-positive findings for BWT in the jejunum (observer 2: 7; observer 3: 4) and fistulas and abscesses (observer 2: 11/5; observer 3: 5/4) were made by the trainees. Interobserver agreement in the jejunum was poor (observer 1/observer 2: κ=0.23; observer 1/observer 3: κ=−0.03) and in the ileum good (observer 1/observer 2: κ=0.78; observer 1/observer 3: κ=0.73). After training, evaluation of BWU (observer 2: 56%, P=0.22; observer 3: 44%, P=0.03), BWT (observer 2: 2; observer 3: 2), and interobserver agreement in the jejunum improved (observer 1/observer 2: κ=0.66; observer 1/observer 3: κ=0.66). However, the number of diagnosed fistulas and abscesses remained high. Conclusion: Before training, most findings of Crohn's disease in the terminal ileum were evaluated with high diagnostic performance by all readers. However, the inexperienced readers evaluated BWU with a low sensitivity and overestimated the number of FIS, number of ABS, and increased BWT in the jejunum. After training, evaluation by inexperienced readers of BWU and increased BWT in the jejunum improved.

Recent advances in CT and MR technology, particularly the advent of multidetector CT (MDCT), the advent of rapidly changing gradients in industry standard MRI scanners, enabling ultrafast sequences, have led to an expansion in the role of cross sectional imaging in the investigation of small bowel disorders. We conducted an evidence-based review of MR enteroclysis (MRE) and how it performs in comparison to CT enteroclysis (CTE) and the gold standard of conventional enteroclysis (CE) for diagnosis of small bowel Crohn's disease and small bowel neoplasia. We used the standard 5 step evidence-based medicine method of ask, search, appraise, apply and evaluate. We found 3 relevant level 1B studies, and one level 3B study. No studies evaluating MRE in small bowel neoplasia were found. MRE does not perform as well as CE in evaluation of fine mucosal detail, but the additional extraluminal detail, and absence of ionising radiation enhances its overall performance. It was not possible to establish the relative diagnostic performances of MRE and CTE from existing literature. CTE does involve patient irradiation. For patients in whom jejunal intubation and enteroclysis is considered to evaluate the small bowel, MRE should be considered the first-line investigation, local resources and expertise permitting.

Name the structures A, B, C, D, and E in this coronal T2 weighted image of the right iliac fossa from a magnetic resonance enteroclysis study⇓. What is magnetic …

current and future applications David H. Bruining, Gauraang Bhatnagar, Jordi Rimola, Stuart Taylor, Ellen M. Zimmermann, Joel G. Fletcher Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA Centre for Medical Imaging, University College, London, UK Department of Radiology, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain Division of Gastroenterology, Hepatology, and Nutrition, University of Florida College of Medicine, Gainesville, FL, USA Department of Radiology, Mayo Clinic, Rochester, MN, USA

Internal fistulas (IFs) and abscesses are the most common complications of Crohn disease (CD). To reliably diagnose and clearly distinguish inflammatory or fibrostenotic manifestations of CD from its complications is of paramount importance to appropriately guide therapeutic decisions. Magnetic resonance enteroclysis (MRE), a recently introduced technique for small bowel imaging, has proved a high efficacy in the depiction of luminal and extraluminal manifestations of CD and holds great promise as a powerful diagnostic tool in the comprehensive diagnostic workup of this disease. As of yet, the characteristic imaging appearance of IFs on MRE has not been described in detail. This article reviews the performance of conventional imaging techniques and the current potential of MRE in the depiction of IFs in CD. Typical imaging morphology and characteristic imaging findings of IFs on MRE are described in detail and a newly defined and highly indicative imaging finding, the "star-sign," is presented and discussed.

Objective: 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. Materials and Methods: 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. Results: 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." Conclusions: Comprehensive MR imaging of SB and LB with DCT improves the identification of modified anatomy and most pathologies in inflammatory and postsurgical bowel.

With the advent of gradient systems the image quality of ultrafast pulse sequences, i.e., half Fourier acquisition single shot turbo spin echo (HASTE), true fast imaging with steady-state processing and fast low angle shot (FLASH), improved substantially and clinical applications including small bowel imaging became feasible. Within this context, magnetic resonance enteroclysis was developed as a comprehensive examination of the small bowel, providing luminal, transmural, and exoenteric diagnostic information of small bowel abnormalities. Clinical applications of magnetic resonance enteroclysis include diagnostic evaluation and follow-up of patients with inflammatory or neoplastic diseases and small bowel obstruction.

Clinical symptoms in patients with Crohn's disease (CD) and internal fistulae (IFs) may be unspecific [1] and require further diagnostic investigations such as laboratory findings, endoscopic and i...

The small intestine has been difficult to examine by traditional endoscopic and radiologic techniques. Until the end of the last century, the small bowel follow through was the primary diagnostic tool for suspected small bowel disease. In recent years capsule endoscopy, deep enteroscopy using balloon-assisted or spiral techniques, computerized tomography and magnetic resonance enteroclysis or enterography have facilitated the diagnosis, monitoring, and management of patients with small bowel diseases. These technologies are complementary, each with its advantages and limitations. In the present article, we will discuss the different options and indications for modern diagnostic methods for visualization of the small bowel. We also try to provide a clinical rationale for the use of these different diagnostic options in less established, newly emerging, indications for small bowel evaluation.

To determine if a nasojejunal tube (NJT) is required for optimal examination of enteroclysis and if patients can be examined only in the supine position.Data were collected from all patients undergoing small bowel (SB) magnetic resonance imaging (MRI) examination over a 32-mo period. Patients either underwent a magnetic resonance (MR) follow-through (MRFT) or a MR enteroclysis (MRE) in the supine position. The quality of proximal and distal SB distension as well as the presence of motion artefact and image quality were assessed by 2 radiologists.One hundred and fourteen MR studies were undertaken (MRFT-49, MRE-65) in 108 patients in the supine position only. Image artefact was more frequent in MRE than in MRFT (29.2% vs 18.4%), but was not statistically significant (P=0.30). Adequate distension of the distal SB was obtained in 97.8% of MRFT examinations and in 95.4% of MRE examinations, respectively. Proximal SB distension was, however, less frequently optimal in MRFT than in MRE (P=0.0036), particularly in patients over the age of 50 years (P=0.0099). Image quality was good in all examinations.All patients could be successfully imaged in the supine position. MRE and MRFT are equivalent for distal SB distension and artefact effects. Proximal SB distension is frequently less optimal in MRFT than in MRE. MRE is, therefore, the preferred MR examination method of the SB.

Background: The aim was to evaluate and compare the diagnostic performance of magnetic resonance enteroclysis (MRE) and wireless video capsule endoscopy (CE) in detecting and classifying small bowel Crohn’s disease (CD) proximal to the terminal ileum. Methods: Nineteen patients with histologically proven CD (M:F 13:6; mean 34 years, range 17– 65) were prospectively included in the study when presenting with clinical signs suggesting stricturing or inflammatory lesions of CD in the proximal small bowel. All patients underwent MRE with an infusion technique and were then admitted to CE. Results: As for the presence or absence of pathology, results of MRE and CE were in total agreement for 44/52 (85%) evaluated segments. In judging lesion severity, MRE and CE yielded identical results in 29/52 (56%) segments. MRE underestimated pathology in 7/52 (14%) segments and revealed more severe pathology in 6/52 (12%) segments. CE identified subtle (n 7) or severe (n 2) mucosal pathology while MRE was normal. CE entirely missed severe inflammatory mural changes depicted in MRE in 1/52 (2%) segments. Conclusions: MRE and CE show good correlation in the detection and localization of inflammatory bowel disease. As for disease activity, MRE is inferior in the detection of superficial mucosal disease but reliably discloses the presence of severe inflammatory changes within the bowel wall and beyond, which may be underestimated from the endoscopic aspect of the mucosal surface. MRE helps to rule out severe stenoses that should be referred for immediate surgical intervention. In conclusion, both modalities are complementary and MRE should be used in more severe cases of Crohn’s disease and in patients who might have involvement beyond the mucosa of the small bowel. (Inflamm Bowel Dis 2008;14:1219 –1228)

Small-bowel manifestations are common complications in Crohn's disease (CD) but can often be underestimated because of diagnostic limitations. Double-balloon enteroscopy (DBE) is a new endoscopic method that provides complete visualization and biopsy sampling of the small bowel with potential implications for diagnosis and therapy. The purpose of this study was to compare the diagnostic yield of DBE and magnetic resonance enteroclysis (MRE) in patients suspected of having small-bowel CD.Ten patients were consecutively selected and included in the study. In all patients a DBE of the small bowel was performed, the endoscopist being unaware of the radiological findings. Evaluation criteria included the presence of pathology, localization, degree, and extension of affection according to predefined morphologic criteria. Samples for histopathological investigation were taken in all patients with abnormal mucosa.In 50% of the patients (5 out of 10) with suspected small-bowel CD, DBE revealed pathological results. Here, in four patients, CD was verified histologically. A new diagnosis had to be established in one patient diagnosed for malignant lymphoma. The medical management had to change in five patients. In two patients, both DBE and MRE showed no pathological results; in three patients, superficial lesions were identified by MRE, whereas DBE was normal.In selected patients with suspected small-bowel lesions, DBE is a promising tool in the diagnostic work-up and provides the advantage of biopsy sampling. In contrast, non-invasive MRE delivers excellent information about extraluminal pathology associated with CD. Both MRE and DBE have the potential to become diagnostic standards that complement each other in patients with suspected complex small-bowel CD.

Purpose: To evaluate the diagnostic accuracy and inter- and intra-observer agreement of magnetic resonance enteroclysis (MRE) in patients with or without Crohn's disease of the small intestine. Material and Methods: 60 consecutive patients with or without Crohn's disease examined with MRE were included. Two observers independently reviewed the MRE examinations, searching for 12 pathological signs. The reference standard was ileoscopy or surgery of the terminal ileum performed in 41 patients. Results: Crohn's disease of the small intestine was found in 24 (40%) patients. MRE findings of increased intestinal wall thickness, intestinal wall enhancement, intestinal wall ulcer, and inflammatory activity of the terminal ileum showed high sensitivity, specificity, and positive and negative predictive values. Intestinal stenosis had sensitivities ranging from 43% to 100%, depending on the cut-off value. Inter- and intra-observer agreement was good or excellent for most pathological signs. However, observer agreement of intestinal wall edema was only fair and moderate. Conclusion: MRE evaluated Crohn's disease with a high diagnostic accuracy in the terminal ileum. Most MRE variables were evaluated with good or excellent observer agreement, indicating that the method was highly reproducible. Our study supports the notion that MRE is an appropriate method for diagnosing Crohn's disease.

Our objective was to assess the diagnostic value of magnetic resonance enteroclysis (MRE) compared with conventional enteroclysis (CE) in patients with Crohn’s disease. A secondary objective was to evaluate the diagnostic accuracy of each different MR sequence. Sixty-six consecutive patients with known Crohn’s disease underwent MRE and CE. Fast imaging employing steady-state acquisition (FIESTA), single-shot fast spin-echo (ssFSE), and contrast-enhanced T1-weighted sequences were assessed by two radiologists who reached a consensus about the following findings: visualization of wall ulcers, pseudopolyps, fistulae, mural stenosis, and mesenteric abnormalities. Standard descriptive statistics and the McNemar test were used. The sensitivity, specificity and accuracy of MRE were 90–87% and 83% for the depiction of parietal ulcers, 84%–88% and 86% for pseudopolyps, 100–94% and 96% for mural stenosis, 93–100% and 94% for fistulae. The number of detected extraluminal findings was significantly higher with MRE (P

MR enteroclysis (MRE) is an emerging technique for the evaluation of small intestinal diseases. Administration of an iso-osmotic water solution through a nasojejunal catheter can guarantee adequate luminal distention, and in combination with ultrafast sequences, such as single shot TSE, true FISP, HASTE and 3D FLASH, results in excellent anatomic demonstration of the small intestine. MR fluoroscopy can be performed during MRE examination to monitor the filling process and might be useful in studying low-grade stenosis or motility related disorders. MRE is a very promising technique for the detection and characterization of involved small bowel segments in patients with Crohn's disease while its diagnostic performance in disclosing lumen narrowing and extramural manifestations and complications of the disease is outstanding. Initial experience shows that MRE is very efficient in the diagnosis of small bowel tumors and can be used in the evaluation of small bowel obstruction.

Summary Magnetic resonance enteroclysis is a promising technique that allows assessment of the small bowel but needs invasive nasoduodenal intubation. We propose a non- invasive distension method for magnetic-resonance imaging (MRI) in which ispaghula, dissolved in an aqueous solution with meglumine gadoterate taken orally over 4 h forms a viscous hydrogel within the intestinal lumen. MRI results from ten volunteers showed good luminal distension, constant signal homogeneity, optimum demarcation of the bowel content from surrounding tissues, and a low rate of artefacts. Our method permits non-invasive high quality MRI of the small bowel.