Answer
Magnetic resonance cholangiopancreatography (MRCP) seems to be a reliable, noninvasive imaging method for diagnosing and following up primary sclerosing cholangitis. The rapid acquisition with relaxation enhancement (RARE) sequence has been found to have the highest diagnostic accuracy of the T2-weighted sequences.
Giovagnoni and associates used high-resolution MRI to study 16 resected rectosigmoid specimens of patients who underwent total colectomy in treatment of severe ulcerative colitis, [24] and the findings suggested that MRI can detect changes of the colon wall in ulcerative colitis. The in vitro results showed that MRI could depict all layers of the colonic wall. In ulcerative colitis specimens, in particular, T1-weighted spin-echo MRI showed thickening and the peculiar abnormal hyperintensity of the mucosal and submucosal layers. The in vivo results confirmed the high signal intensity of the mucosal and submucosal layers.
Gadolinium-based contrast agents have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. [11, 9]
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Double-contrast barium enema study shows changes of early disease. Note the granular mucosa.
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Double-contrast barium enema studies show changes of early disease. Note the granular mucosa.
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Double-contrast barium enema studies in a 44-year-old man known to have a long history of ulcerative colitis. Images show total colitis and extensive pseudopolyposis.
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Plain abdominal radiograph in a patient (same as in the previous image) who presented with an acute exacerbation of his symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
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Plain abdominal radiograph obtained 2 days later in the same patient as in the previous image shows distention of the transverse colon associated with mucosal edema. The maximum transverse diameter of the transverse colon is 7.5 cm. The patient was treated for toxic megacolon.
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A 22-year-old man presented with abdominal pain, passage of blood and mucus per rectum, abdominal distention, fever, and disorientation. Findings from sigmoidoscopy confirmed ulcerative colitis. Abdominal radiographs obtained 2 days apart show mucosal edema and worsening of the distention in the transverse colon. The patient's clinical condition deteriorated over the next 36 hours despite steroid and antibiotic therapy, and the patient had to undergo total colectomy and ileostomy.
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Plain abdominal radiograph in a patient with known ulcerative colitis who presented with abdominal pain, peritonism, and leukocytosis. At surgery, a perforated toxic megacolon superimposed on ulcerative colitis was confirmed.
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Increased postrectal space is a known feature of ulcerative colitis.
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Plain abdominal radiograph on a patient with known ulcerative colitis who presented with an acute exacerbation of his symptoms. Image shows thumbprinting in the region of the splenic flexure of the colon.
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Double-contrast barium enema study shows pseudopolyposis of the descending colon.
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Single-contrast enema study in a patient (same patient as in the previous image) with known ulcerative colitis in remission shows a benign stricture of the sigmoid colon.
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Plain abdominal radiograph in a 26-year-old with a 10-year history of ulcerative colitis shows a long stricture/spasm of the ascending colon/cecum. Note the pseudopolyposis in the descending colon.
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Single-contrast enema study in a patient with total colitis shows mucosal ulcers with a variety of shapes, including collar-button ulcers, in which undermining of the ulcers occurs, and double-tracking ulcers, in which the ulcers are longitudinally orientated.
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Double-contrast barium enema study shows total colitis. Note the granular mucosa in the cecum/ascending colon and multiple strictures in the transverse and descending colon in a patient with a more than a 20-year history of ulcerative colitis.
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Single-contrast barium enema study shows burnt-out ulcerative colitis.
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Scan obtained with technetium-99m hexamethylpropylamine oxime (HMPAO)–labeled WBCs in a patient with active colitis involving the transverse and descending colon.
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Intravenous urogram shows features of ankylosing spondylitis.
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Lateral radiograph of the lumbar spine shows a bamboo spine.
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Single-contrast barium enema study in a patient with Shigella colitis.
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Postevacuation image obtained after a single-contrast barium enema study shows extensive mucosal ulceration resulting from Shigella colitis.
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Double-contrast barium enema studies show granular mucosa associated with Campylobacter colitis.
