Objectives

We review the indications and technique for assessment of colonic transit times using radio-opaque markers . We demonstrate how to interpret the imaging findings and advise on a structured reporting template.

Background

Constipation is a common and distressing clinical condition especially in the elderly population. In the absence of warning signs, they are usually contributed to colonic inertia or ano-rectal functional disorders. Colonic transit time studies are useful to differentiate the two and also specifies which colonic segment is abnormal, thus altering management.

Imaging findings OR Procedure findings

We review the imaging features of normal colonic transit studies, slow colonic transit, segmental inertia and outlet obstruction.

Conclusion

Although an age old technique, it is an easy, inexpensive and effective test to differentiate the cause of constipation and guide management.

Objectives

To review the technique of MR enterography (MRE) and imaging findings in the assessment of small bowel Crohn disease (CD) .

Background

MRE is being increasingly used in the assessment of Crohn disease due to its non-invasive nature, superior soft tissue contrast and lack of ionising radiation. Although Crohn disease has a progressive course, there is no stepwise progression between these disease phases, and various phases may exist at the same time. While endoscopy is suitable in the detection of early mucosal disease and facilitates biopsy, MR yields insightful information about penetrating disease and extra-intestinal manifestations. Accurate assessment is vital for optimising medical and surgical therapies for these patients.

Imaging findings OR Procedure findings

We review MR protocol and assessment for optimal bowel distension with oral contrast as it has a significant bearing on the interpretation of MR enterography. We also analyse the intestinal and extra-intestinal manifestations of Crohn disease like mural oedema, ulceration, strictures, pseudo-sacculation, fistula, abscess, mesenteric oedema , hypervascularity, fat wrapping and lymphadenopathy.

Conclusion

Familiarity with MR Enterography is essential for radiologists and gastroenterologists as the technique evolves and is further incorporated into the clinical management of Crohn disease.

Objectives

To review the indications, normal post-procedure imaging appearance and complications of endoscopic cystogastrostomy for pancreatic collections.

Background

Pancreatic collections in a setting of acute or recurrent pancreatitis can be complex in presentation, diagnosis and management. Image guided endoscopic techniques for drainage are emerging as the first line therapeutic option as it avoids the need for open incision or external drainage, has a high success rate, low morbidity and mortality.

However, due to its limited view, difficult manoeuvring and steep learning curve endoscopic cystogastrostomy can present with rare but significant complications. In view of its frequent use, its important for the general radiologist to be aware of its normal imaging appearance and complications.

Imaging findings OR Procedure findings

We review normal post-intervention appearances and analyse imaging features of complications like perforation, haemorrhage, infection, stent blockage , migration and malposition.

Conclusion

Despite its rare complications, endoscopic drainage is preferred in most clinical scenarios and often augment surgical techniques. As we encounter them more frequently, we attempt to discuss what the general radiologist should know.

Objectives

We review the indications and technique for assessment of colonic transit times using radio-opaque markers . We demonstrate how to interpret the imaging findings and advise on a structured reporting template.

Background

Constipation is a common and distressing clinical condition especially in the elderly population. In the absence of warning signs, they are usually contributed to colonic inertia or ano-rectal functional disorders. Colonic transit time studies are useful to differentiate the two and also specifies which colonic segment is abnormal, thus altering management.

Imaging findings OR Procedure findings

We review the imaging features of normal colonic transit studies, slow colonic transit, segmental inertia and outlet obstruction.

Conclusion

Although an age old technique, it is an easy, inexpensive and effective test to differentiate the cause of constipation and guide management.

Objectives

To review the technique of MR enterography (MRE) and imaging findings in the assessment of small bowel Crohn disease (CD) .

Background

MRE is being increasingly used in the assessment of Crohn disease due to its non-invasive nature, superior soft tissue contrast and lack of ionising radiation. Although Crohn disease has a progressive course, there is no stepwise progression between these disease phases, and various phases may exist at the same time. While endoscopy is suitable in the detection of early mucosal disease and facilitates biopsy, MR yields insightful information about penetrating disease and extra-intestinal manifestations. Accurate assessment is vital for optimising medical and surgical therapies for these patients.

Imaging findings OR Procedure findings

We review MR protocol and assessment for optimal bowel distension with oral contrast as it has a significant bearing on the interpretation of MR enterography. We also analyse the intestinal and extra-intestinal manifestations of Crohn disease like mural oedema, ulceration, strictures, pseudo-sacculation, fistula, abscess, mesenteric oedema , hypervascularity, fat wrapping and lymphadenopathy.

Conclusion

Familiarity with MR Enterography is essential for radiologists and gastroenterologists as the technique evolves and is further incorporated into the clinical management of Crohn disease.

Objectives

To review the indications, normal post-procedure imaging appearance and complications of endoscopic cystogastrostomy for pancreatic collections.

Background

Pancreatic collections in a setting of acute or recurrent pancreatitis can be complex in presentation, diagnosis and management. Image guided endoscopic techniques for drainage are emerging as the first line therapeutic option as it avoids the need for open incision or external drainage, has a high success rate, low morbidity and mortality.

However, due to its limited view, difficult manoeuvring and steep learning curve endoscopic cystogastrostomy can present with rare but significant complications. In view of its frequent use, its important for the general radiologist to be aware of its normal imaging appearance and complications.

Imaging findings OR Procedure findings

We review normal post-intervention appearances and analyse imaging features of complications like perforation, haemorrhage, infection, stent blockage , migration and malposition.

Conclusion

Despite its rare complications, endoscopic drainage is preferred in most clinical scenarios and often augment surgical techniques. As we encounter them more frequently, we attempt to discuss what the general radiologist should know.