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CaseDiscussionTangChunXiang2016/5/25Axialarterialphase

Axialarterialphase

Coronalarterialphase

Sagittalvenousphase

CrohndiseaseAninflammatorydiseaseofthegastrointestinaltractthattypicallyhasanindolentcourseCharacterizedbyintestinalulceration,strictures,andfistulaformationCommonlyaffectsyoungadults,smallbowel,particularlytheterminalileumSmallbowelinvolvementinCrohndiseaseistypicallytransmural,withskiplesions

CTandMRI

Introduction--Crohndisease

CombsignFathalosignBowelwallenhancementBowelwallthicknessStrictureandfistulaMesenteric/intra-abdominalabscess(15%-20%)orphlegmonformationUlcerationsandlossofhaustrationCreepingfat

ImagingfindingsonCTandMRI

Fathalosign

Infiltrationofthesubmucosawithfat,betweenthemuscularisandthemucosaConfusedwiththefatringsignofmesentericpanniculitisNearlypathognomonicofinflammatoryboweldisease(Crohndiseaseandulcerativecolitis)

ImagingfindingsonCTandMRIHomogeneousMucosalLayeredPatternofenhancementBowelwallthickness

Normalbowelwallthickness：lumendistended，1-2mm；lumencollapsed,3-4mm

Mild:3-5mm

Moderate:5-7mmMarked:>7mmOneofthemostcommonsigns,butnotspecificCorrelateswellwiththeseverityofthediseaseactivityMeasurewhenlumendistendedwellBlackborderartifactscandistortthicknessmeasurements

ImagingfindingsonCTandMRI

Stricture

AcomplicationofCrohndiseaseReversiblestricturesproducedbyactivediseaseAlackofenhancementandlossofstratificationmightbeseeninthepresenceoftransmuralfibrosis

ImagingfindingsonCTandMRI

Fistula

ThedetectionofpenetratingdiseaseisimportantandmayredirectoraltermanagementEnteroentericfistula,enterovesicalfistula,andinterloopabscessCTenterographyresultedinaccuratedetectionoffistulasin94%ofcases

ImagingfindingsonCTandMRI

Abscess

OftenseeninpatientswithsevereactiveCrohndiseaseExtraluminalfluidcollectionswithoutcommunicationwiththebowellumenFluidcollectionswithanenhancingwallwithorwithoutassociatedair

ImagingfindingsonCTandMRI

LossofhaustrationBoththecolonandthesmallbowelareinvolvedin30%–60%Involvementofthecolonalonein20%–35%AdecreaseofhaustralfoldsAcommonfindinginulcerativecolitis

ImagingfindingsonCTandMRI

CreepingfatFibrofattyproliferationoffatwrapping,differentnameforhypertrophyofthesubserosalfatCommonfindinginlongstandingCrohndiseaseTheimageshowscreepingfatsurroundingbowelloops

ImagingfindingsonCTandMRI

CTandMRIAllowingvisualizationoftheentirethicknessofthebowelwall

Summary

Normalbowelwallthickness：lumendistended，1-2mm；lumencollapsed,3-4mm

Mild:3-5mm

Moderate:5-7mmMarked:>7mm

CTandMRI

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