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Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

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An Erratum to this article was published on 02 December 2014

Abstract

Purpose

The purpose of this study was to evaluate whether affected bowel in Crohn’s disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images.

Materials and methods

5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn’s disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn’s disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted.

Results

For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn’s disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn’s patients, but not in the overall small bowel between normal-MRE patients and Crohn’s disease patients.

Conclusion

Abnormal Crohn’s small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.

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Author information

Authors and Affiliations

  1. Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA

    Flavius F. Guglielmo, Donald G. Mitchell, Patrick L. O’Kane, Sandeep P. Deshmukh & Laurence Parker

  2. Department of Radiology, Methodist Hospital, Thomas Jefferson University, 2301 South Broad Street, Philadelphia, PA, 19148, USA

    Christopher G. Roth

  3. Shore Medical Center, 100 Medical Center Way, Somers Point, NJ, 08244, USA

    Ilene Burach

  4. Our Lady of Lourdes Medical Center, 1600 Haddon Avenue, Camden, NJ, 08103, USA

    Aaron Burns

  5. Radiology Center, M.C. 34-46, 1000 E Mountain Blvd., Wilkes-Barre, PA, 18711, USA

    Susan Dulka

Authors
  1. Flavius F. Guglielmo
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  2. Donald G. Mitchell
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  3. Patrick L. O’Kane
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  4. Sandeep P. Deshmukh
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Corresponding author

Correspondence to Flavius F. Guglielmo.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Figure S1. Cine balanced steady state free precession (cine BSSFP) series showing the 5 progressive grades of peristalsis ranging from Peristalsis Grade 1 (slowest) to Peristalsis Grade 5 (fastest). (S1A = Peristalsis Grade 1, S1B = Peristalsis Grade 2, S1C = Peristalsis Grade 3, S1D = Peristalsis Grade 4, S1E = Peristalsis Grade 5)

Supplementary Figure S1A. (Multimedia Video)—Cine balanced fast field echo (BFFE) series (TR 3.1 ms, TE 1.5 ms,matrix 160 x 160, flip angle 45°, thickness 8 mm) showing Peristalsis Grade 1 (MP4 7225 kb)

261_2014_258_MOESM2_ESM.mp4

Supplementary Figure S1B. (Multimedia Video)—Cine balanced fast field echo (BFFE) series (TR 3.2 ms, TE 1.6 ms,matrix 160 x 160, flip angle 45°, thickness 8 mm) showing Peristalsis Grade 2 (MP4 7129 kb)

261_2014_258_MOESM3_ESM.mp4

Supplementary Figure S1C. (Multimedia Video)—Cine balanced fast field echo (BFFE) series (TR 3.3 ms, TE 1.6 ms,matrix 160 x 160, flip angle 45°, thickness 8 mm) showing Peristalsis Grade 3 (MP4 6839 kb)

261_2014_258_MOESM4_ESM.mp4

Supplementary Figure S1D. (Multimedia Video)—Cine balanced fast field echo (BFFE) series (TR 3.2 ms, TE 1.6 ms,matrix 160 x 160, flip angle 45°, thickness 8 mm) showing Peristalsis Grade 4 (MP4 8658 kb)

261_2014_258_MOESM5_ESM.mp4

Supplementary Figure S1E. (Multimedia Video)—Cine true fast imaging with steady-state precession (TRUE FISP) series (TR 4.9 ms, TE 2.2 ms, matrix 320 x 240, flip angle 65°, thickness 8 mm) showing Peristalsis Grade 5 (MP4 9605 kb)

Supplementary Figure S2. Active Crohn’s disease of the terminal ileum in a 33 year old woman

Supplementary Figure S2A. (Multimedia video)—Cine balanced fast field echo (BFFE) series (TR 3.2 ms, TE 1.6 ms, matrix 176 × 178, flip angle 45°, thickness 8 mm) showing decreased peristalsis of the abnormal terminal ileum (arrow) compared to the remainder of the small bowel (MP4 1153 kb)

261_2014_258_MOESM7_ESM.tif

Supplementary Figure S2B. Coronal (TR ∞, TE 200 ms, matrix 308 × 268, thickness 6 mm) T2-weighted single-shot fast spin echo (FSE) image showing mild terminal ileum wall thickening and wall edema (blue arrows) (TIF 1264 kb)

261_2014_258_MOESM8_ESM.tif

Supplementary Figure S2C. 3-D dynamic post-contrast coronal T1 W high-resolution isotropic volume examination (THRIVE) image (TR 4.1 ms, TE 2 ms, matrix 168 × 167, thickness 5 mm) showing increased late arterial transmural enhancement predominantly in the mesenteric wall (arrows) with enlarged adjacent lymph nodes (arrowhead) consistent with active Crohn’s disease (TIF 882 kb)

Supplementary Figure S3. Active Crohn’s disease of the terminal ileum in a 25 year old woman

Supplementary Figure S3A. (Multimedia video)—Cine balanced fast field echo (BFFE) series (TR 3.2 ms, TE 1.6 ms, matrix 160 × 160, flip angle 45°, thickness 8 mm) showing decreased peristalsis of the abnormal terminal ileum (arrows) compared to the remainder of the small bowel (MP4 3047 kb)

261_2014_258_MOESM10_ESM.tif

Supplementary Figure S3B. Coronal T2-weighted single-shot fast spin echo (FSE) images (TR ∞, TE 80 ms, matrix 256 × 154, thickness 6 mm) showing mild terminal ileum wall thickening (arrows) (TIF 925 kb)

261_2014_258_MOESM11_ESM.tif

Supplementary Figure S3C. 3-D dynamic (S3C) and delayed post-contrast (S3D) coronal T1W high-resolution isotropic volume examination (THRIVE) images (TR 4.2 ms, TE 2.1 ms, matrix 256 × 163, thickness 5 mm) showing mucosal fold thickening with increased mucosal and transmural late arterial enhancement (S3C) and delayed enhancement (S3D) with ulceration along the lateral wall (arrows) consistent with active Crohn’s disease (TIF 891 kb)

261_2014_258_MOESM12_ESM.tif

Supplementary Figure S3D. 3-D dynamic (S3C) and delayed post-contrast (S3D) coronal T1W high-resolution isotropic volume examination (THRIVE) images (TR 4.2 ms, TE 2.1 ms, matrix 256 × 163, thickness 5 mm) showing mucosal fold thickening with increased mucosal and transmural late arterial enhancement (S3C) and delayed enhancement (S3D) with ulceration along the lateral wall (arrows) consistent with active Crohn’s disease (TIF 835 kb)

Supplementary Figure S4. Active inflammatory and chronic Crohn’s disease of the terminal ileum with adjacent phlegmon in a 21 year old woman

Supplementary Figure S4A. (Multimedia video)—Cine fast imaging employing steady-state acquisition (FIESTA) series (TR 3.8 ms, TE 1.7 ms, matrix 224 × 288, flip angle 70°, thickness 8 mm) showing decreased peristalsis of the abnormal terminal ileum (arrow) compared to the remainder of the small bowel, and adjacent phlegmon (arrowhead). There is upstream small bowel dilatation (MP4 2458 kb)

261_2014_258_MOESM14_ESM.tif

Supplementary Figure S4B. Coronal T2-weighted single-shot fast spin echo (FSE) image (TR ∞, TE 181 ms, matrix 256 × 224, thickness 5 mm) showing wall thickening of the terminal ileum (arrows) and adjacent phlegmon (arrowheads) (TIF 947 kb)

261_2014_258_MOESM15_ESM.tif

Supplementary Figure S4C. Dynamic post-contrast coronal liver acquisition with volume acceleration (LAVA) images (TR 4 ms, TE 1.76 ms, matrix 320 × 224, thickness 4.4 mm) showing terminal ileum wall thickening and mucosal hyperenhancement (arrows) (TIF 584 kb)

261_2014_258_MOESM16_ESM.tif

Supplementary Figure S4D. Dynamic post-contrast coronal liver acquisition with volume acceleration (LAVA) images (TR 4 ms, TE 1.76 ms, matrix 320 × 224, thickness 4.4 mm) showing terminal ileum wall thickening and mucosal hyperenhancement (arrows) and enhancing adjacent phlegmon (arrowheads) (TIF 860 kb)

Supplementary Figure S5. Active inflammatory and chronic Crohn’s disease of the mid ileum in a 66 year old man

Supplementary Figure S5A. (Multimedia video)—Cine balanced fast field echo (BFFE) series (TR 3.2 ms, TE 1.6 ms, matrix 160 × 160, flip angle 45°, thickness 8 mm) showing decreased peristalsis of the abnormal mid ileum (arrows) compared to the remainder of the small bowel with mild upstream small bowel dilatation (MP4 2969 kb)

261_2014_258_MOESM18_ESM.tif

Supplementary Figure S5B. Coronal T2-weighted single-shot image (TR ∞, TE 80 ms, matrix 256 × 154, thickness 6 mm) showing wall thickening, wall edema, and areas of narrowing with skip lesions in the mid ileum (arrows) (TIF 1041 kb)

261_2014_258_MOESM19_ESM.tif

Supplementary Figure S5C. 3-D dynamic post-contrast coronal T1W high-resolution isotropic volume examination (THRIVE) image (TR 4.16 ms, TE 2.1 ms, matrix 256 × 163, thickness 5 mm) showing wall thickening with mucosal and serosal hyperenhancement causing a stratified enhancement pattern (arrows) (TIF 999 kb)

261_2014_258_MOESM20_ESM.tif

Supplementary Figure S5D. 3-D delayed post-contrast coronal THRIVE image (TR 4.16 ms, TE 2.1 ms, matrix 256 × 163, thickness 5 mm) showing more homogeneous wall enhancement (TIF 989 kb)

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Guglielmo, F.F., Mitchell, D.G., O’Kane, P.L. et al. Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign. Abdom Imaging 40, 1150–1156 (2015). https://doi.org/10.1007/s00261-014-0258-y

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