Pe d i a t r i c I m a g i n g O r i g i n a l R e s e a r c h

Cronin et al.
MR Small-Bowel Follow-Through in Pediatric Patients

Pediatric Imaging
Original Research
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MR Small-Bowel Follow-Through
FOCUS ON:

for Investigation of Suspected

Pediatric Small-Bowel Pathology
Carmel G. Cronin1 OBJECTIVE. The purpose of our study was to evaluate the potential role of an MR small-
Derek G. Lohan bowel follow-through (SBFT) technique in the investigation of suspected pediatric small-
Ann Michelle Browne bowel abnormalities.
Clare Roche MATERIALS AND METHODS. Between September 2003 and January 2008, 280 MR
David OKeeffe SBFT examinations were performed for investigation of known or suspected small-bowel ab-
normalities, including 19 of 280 examinations in 17 children (mean age, 13 years; age range
Joseph M. Murphy
617 years), representing the current study population. A standardized technique was used in
Cronin CG, Lohan DG, Browne AM, Roche C, all cases, including axial and coronal steady-state free precession acquisitions at successive
OKeeffe D, Murphy JM time intervals until completion. Retrospective analysis of the studies obtained was performed
by two radiologists, who blindly and independently scored predefined small-bowel segments
according to the degree of luminal distention achieved. Any pathologic lesions detected were
also noted. Indicators of examination success as a whole (volume, tolerability, and side effects
of oral contrast material) were also noted, as were details pertaining to examination duration
(number of visits to the MR table, total table time).
RESULTS. Oral contrast medium was ingested and subsequent imaging was possible in
all patients; 84.2% of patients tolerated the oral contrast material well and 15.8% showed
moderate tolerance. The MR table time ranged from 2 to 4 minutes, without early termination
of the examination in any case. The average number of visits to the MR table was 1.3 (range,
13). The mean duration for complete small-bowel evaluation was 25 minutes (range, 2060
minutes). The mean distention scores were well within the diagnostic range in all small-bow-
el segments for both observers, with a substantial degree of interobserver agreement in score
assignment ( = 0.73). Pathologic lesions were identified in 53% of studies.
CONCLUSION. MR SBFT represents a promising, and perhaps optimal, technique
for pediatric small-bowel evaluation for a variety of reasons, including its high tolerability,
lack of ionizing radiation, avoidance of duodenojejunal intubation, and excellent luminal dis-
tention achieved. Furthermore, this technique allows pseudodynamic functional imaging
while also showing extraluminal disease, without known biologic risk.

Keywords: children, Crohns disease, MR small-bowel

S
follow-through (SBFT), pediatric patients, small-bowel mall-bowel pathology is not rare
disease in both pediatric and adult popu-
lations. Several entities, including
DOI:10.2214/AJR.08.1183
Crohns disease, celiac disease,
Received May 6, 2008; accepted after revision the polyposis syndromes, intestinal malrota-
August 1, 2008. tion, luminal stenosis, and atresia, may mani-
1
fest in childhood. Furthermore, many of these
All authors: Department of Radiology, University College
Hospital, Newcastle Rd., Galway, Ireland. Address
conditions require frequent, repetitive imaging
correspondence to C. G. Cronin for diagnosis, assessment of response to treat-
(carmelcronin2000@hotmail.com). ment, and surveillance. Because the cumula-
tive lifetime radiation exposure for patients
AJR 2009; 192:12391245 in this age group may culminate in a very
0361803X/09/19251239
real risk of cancer induction, any technique
that combines high sensitivity for detection
American Roentgen Ray Society of soft-tissue abnormalities with limited or
absent ionizing radiation exposure may have
significant implications on future patient
care [1].
MR small-bowel follow-through (SBFT)
offers a number of distinct advantages over
its projectional and cross-sectional alterna-
tives, including absence of associated ioniz-
ing radiation exposure, multiplanar imaging
capabilities, superb contrast and temporal
resolution, facilitation of sequential imag-
ing over prolonged periods of time, and ob-
viation of potentially nephrotoxic contrast
medium administration. Although MR
SBFT has proven efficacy in imaging the
small bowel in the adult population [16],

AJR:192, May 2009 1239

 Cronin et al.

reports describing the feasibility and suc- Materials and Methods September 2003 to January 2008, 280 MR SBFT
cess of this technique in pediatric patients Subjects examinations were performed at a single institute.
are extremely limited, hence the purpose of Institutional review board approval was These examinations included 17 children who
this study. obtained for this study. During the period from underwent MR SBFT (19 examinations) using a

TABLE 1: Indications and Results of 19 MR Small-Bowel Follow-Through (SBFT) Examinations in 17 Patients

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Oral Contrast Material

Mean
Quantity Overall Distention
Patient Age Scan Consumed Side Bowel Score for
No. Sex (y) No. Tolerability (mL) Effects Indication MR SBFT Findings Distention Study
1 M 13 1 Well > 800 NS Query for Crohns disease Crohns disease in Ileum Excellent 2.8
and terminal ilium
1 M 15 2 Well > 800 NS Query for Crohns disease exacerbation Crohns disease in Excellent 3.0
terminal ilium
2 F 16 1 Well > 800 NS Diarrhea, anemia, high ESR, query for Crohns disease in Ileum Excellent 2.8
Crohns disease and terminal ilium
2 F 17 2 Well > 800 NS Persistent symptoms, weight loss, query for Worsening Crohns Excellent 2.8
progressive Crohns disease disease in Ileum and
terminal ilium
3 M 17 1 Well > 800 NS Indeterminate colitis, query for terminal ileal Colitis; terminal ilium Excellent 2.8
involvement normal
4 F 16 2 Well > 800 NS Diarrhea, weight loss, query for Crohns Crohns disease of ileum Excellent 2.8
disease and terminal ilium, skip
lesions
5 F 17 1 Well > 800 NS Crohns disease at colonoscopy; query for Crohns disease of ileum Excellent 2.2
disease extent and terminal ilium
6 F 15 1 Moderate 400 Nausea Diarrhea, unable to tolerate barium Dilated ileal loop Moderate 1.4
follow-through examination
7 M 13 1 Well > 800 NS Known Crohns disease Crohns disease of terminal Excellent 2.8
ilium
8 F 16 1 Well 600 NS RIF pain Crohns disease; phlegmon Excellent 2.2
mass of terminal ilium
9 M 17 1 Well > 800 NS Rectal Crohns disease on steroids, no Normal Excellent 3.0
gastrointestinal symptoms, normal barium
follow-through; query for small-bowel
disease
10 M 14 1 Well > 800 NS RIF pain after appendicectomy; query for Normal Excellent 2.6
thickening of terminal ilium on standard CT
11 M 13 1 Well > 800 NS RIF pain; subsequent diagnostic laparoscopy Normal Excellent 3.0
showed adhesions around normal appendix
12 M 6 1 Well > 800 NS Rectal bleeding; query for Meckels Normal Excellent 3.0
diverticulum; subsequent normal scan
13 F 11 1 Well > 800 NS Appendicectomy and abscess in 2003; Normal Excellent 2.8
diarrhea (23 d), anemia, high ESR, normal
ultrasound
14 M 9 1 Well > 800 NS Diarrhea, rectal bleeding; blood tests normal Normal Excellent 2.8
15 M 15 1 Well > 800 NS Recurrent perianal abscess, no gastrointestinal Normal Excellent 3.0
symptoms; possible smooth terminal ilium
stricture on barium follow-through
examination; normal terminal ilium at
colonoscopy; query for Crohns disease
16 M 13 1 Moderate 350 Nausea Recurrent perianal abscess, no Normal Moderate 1.6
gastrointestinal symptoms, normal
blood test; query for Crohns disease
17 M 11 1 Moderate 400 Vomiting Diarrhea Normal Moderate 1.8
NoteSmall-bowel distention was scored using a visual assessment grading scale that ranged from 1 to 3. A score of 1 was taken to represent poor; 2, moderate; and 3,
excellent small-bowel distention. ESR = erythrocyte sedimentation rate, RIF = right iliac fossa, NS = not specified.

1240 AJR:192, May 2009

 MR Small-Bowel Follow-Through in Pediatric Patients
standardized technique for evaluation of known or
clinically suspected small-bowel abnormality.
Specific indications are outlined in Table 1.
The currently analyzed pediatric group is from a
similar database from previous articles [24, 7],
but the patients are unique. There is overlap of two
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patients with McKenna et al. [6]; however, this
research effort is unique in its objective. The
images obtained were retrospectively evaluated on
a PACS.
Technique
All patients were instructed to fast from the
preceding midnight. No bowel preparation,
medications to promote gastric emptying or bowel
relaxation, or paramagnetic contrast agents were
administered before imaging. Bowel distention
was achieved using a single packet of polyethylene
glycol (PEG) solution (Klean Prep, Norgine)
diluted in 1,000 mL of water and a small amount
of orange flavoring added to render the mixture
more palatable [24]. Patients were instructed to
consume at least 600 mL of the 1,000 mL solution
over a 10- to 15-minute period, as permitted by
individual patient tolerance [5, 8]. PEG is a high-
osmolarity, nonabsorbed, nonfermented contrast
medium that provides exquisite intraluminal
contrast and luminal distention (PEG macrogol
3350, 59.0 g; anhydrous sodium sulfate, 5.685 g;
sodium bicarbonate, 1.685 g; sodium chloride,
1.465 g; potassium chloride, 0.7425 g). All patients
and their parents were provided with an
information sheet detailing the procedure and the
potential risk of diarrhea due to PEG before
commencement of the examination.
MR Protocol
Initial images were obtained 20 minutes after
commencement of contrast ingestion, irrespective
of the patients ability to consume the entire contrast
AJR:192, May 2009 1241
mixture [24]. Each phase of imaging involved
coronal and axial 2D acquisitions from the
diaphragm to the symphysis pubis in craniocaudal
extent and the entire abdominal cavity in the
transverse plane. Delayed repeat imaging was
performed as required until the contrast bolus had
passed to the colon, in accordance with the image
acquisition algorithm suggested by Lohan et al. [7].
Examination completion was defined as the pres
ence of contrast material in the cecum or further
distally, having achieved prior diagnostic-quality
distention of the small bowel throughout its length.
Patients were brought to the MR table only for
image acquisition and remained in the preparation
room between sequential phases of imaging. One
parent was allowed to remain in the scanning room
with the patient if so desired after full safety
screening of the parent involved. Earplugs were
provided to prevent acoustic discomfort or trauma
to the accompanying parent. No sedation of any
kind, either oral or IV, was used to improve
acceptance or success of the MR examination.
Patients were imaged in the supine position
because neither the supine nor prone position has
been shown to be superior to the other in terms of
lesion detection on prior comparative studies [2].
All examinations were performed on a Symphony
1.5-T MRI system (Siemens Medical Solutions)
equipped with high-performance gradient coils,
characterized by a maximum gradient amplitude
of 52 mT/m and a slew rate of 125 T/m/s. Large
flexible surface coils were used in addition for
optimal signal reception. True fast imaging with
steady-state free precession (SSFP) acquisitions
was obtained during suspended inspiration, the
field of view encompassing from the diaphragm to
the symphysis pubis with the following imaging
parameters: TR/TE, 4.72/2.36 and section
thickness, 8-mm axial (distance factor, 20%) and
5-mm coronal (distance factor, 0%).
Fig. 1Axial MR small-
bowel follow-through
image in 13-year-old boy
who had normal small
bowel shows moderate
small-bowel distention
(arrow).
Data Analysis
Retrospective chart analysis was also perform
ed, gathering information regarding patient symp
toms, indication for the MR SBFT examination,
preexisting conditions, and correlating investiga
tional results. The amount of ingested oral
contrast agent is routinely noted immediately
after the examination as part of departmental
policy and was used in our study to score patient
tolerance: poor (< 300 mL), moderate (300600
mL), and well (> 600 mL). Total and average
numbers of visits to the MR table, derived from
information available on the PACS system, were
also noted, as was the total time spent on the MR
table (table time).
Image Analysis
Each of the MR SBFT examinations was
blindly and independently reviewed by two con
sultant radiologists with an interest in MRI and
gastrointestinal disease. For the purpose of image
assessment, the small bowel was considered as
comprising five distinct segments: the duodenum,
jejunum, proximal ileum, distal ileum, and
terminal ileum [2]. Images were blindly and
qualitatively evaluated with regard to degree of
small-bowel distention using a visual assessment
grading scale that ranged from 1 to 3, as validated
in prior studies [24]. A score of 1 was taken to
represent poor; 2, moderate; and 3, excellent
small-bowel distention. Scores of 2 or 3 were
taken to indicate an examination of diagnostic
quality. In assigning scores to each anatomic
segment, observers were requested to determine
the adequacy of small-bowel distention according
to visibility of the bowel lumen, endoluminal
folds, and bowel wall. Jejunal loops were
distinguished from ileal loops both by their
respective locations and by the configuration of
their folds (i.e., more closely packed, jejunum;
sparse, ileum) [2]. The number and location of
intraluminal, mural, and extraluminal pathologic
lesions depicted at each segment were recorded
and compared for each observer. Differences in
mean examination durations were assessed using
the unpaired Students t test. Interobserver
agreement with regard to small-bowel distention
scores assigned was assessed using the kappa
coefficient, with = 0 indicating poor agreement;
= 0.010.20, slight agreement; = 0.210.40,
fair agreement; = 0.410.60, moderate
agreement; = 0.610.80, substantial agreement;
and = 0.811.00, excellent agreement.
Results
Seventeen children (11 boys and six girls;
age range, 617 years; mean age, 13.8 years)
underwent 19 MR SBFT examinations. Two

children underwent follow-up MR SBFT ex-
aminations, one for acute symptomatic exac-
erbation of Crohns disease and the second
for progressive Crohns disease.
Oral contrast material was ingested and
subsequent imaging was possible in all pa-
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tients. No significant adverse effects were en-
countered after contrast ingestion. In 16
(84.2%) of 19 examinations, the oral contrast
agent was well tolerated, whereas patients in
three (15.8%) of 19 examinations had a mod-
erate ability to tolerate contrast ingestion. Two
children experienced nausea and one, vomit-
ing during the ingestion process; these symp-
toms limited oral contrast consumption to
58% of the recommended amount in one pa-
tient (350 mL) and 66% of recommended
amount in two children (400 mL). This inabil-
ity to comply with contrast instructions result-
ed in moderate distention in these three cases
(mean distention scores of 1.4, 1.6, and 1.8).
The mean number of visits to the MR ta-
ble was 1.3 (range, 13 visits). Of our 19 pa-
tients, 31.6% (6/19) underwent delayed im-
aging: 26.3% (5/19) underwent one delayed
study and 5.3% (1/19) underwent two de-
layed studies. The mean duration for com-
plete small-bowel evaluation was 25 minutes
(range, 2060 minutes). No significant dif-
ference was identified between mean exami-
nation duration in patients with negative
studies and those with positive findings (p >
0.05, Students t test). All patients tolerated
the MRI study time, the table time ranging
from 2 to 4 minutes.
Fig. 316-year-old girl with Crohns disease.
A and B, Excellent ileal distention is visualized at MR small-bowel follow-through (SBFT). Pathologically, MR SBFT shows concentric, thickened small-bowel walls with
attenuated valvulae conniventes (straight arrows). There is fibrofatty proliferation resulting in separation of bowel loops (white arrowheads, B) and free fluid in pelvis
(black arrowhead, B). Comb sign seen in B is due to inflammatory hyperemia of mesenteric vasculature, which suggests active disease (curved arrows, A).
1242 AJR:192, May 2009
Cronin et al.
TABLE 2: Mean Distention Score per Small-Bowel Segment for
Each Observer
Observer Duodenum Jejunum Proximal Ileum Distal Ileum Terminal Ileum
1 2.3 2.3 2.5 2.7 2.6
2 2.3 2.1 2.5 2.6 2.6
NoteSmall-bowel distention was scored using a visual assessment grading scale that ranged from 1 to 3. A
score of 1 was taken to represent poor; 2, moderate; and 3, excellent small-bowel distention.
Overall bowel distention was excellent in 15.8%. The reliable degree of segmental
16 (84.2%) of 19 patients and moderate in small-bowel distention provided facilitates vi-
three (15.8%) of 19 examinations (Table 1 and sualization of luminal, mural, and extramural
Figs. 1 and 2). Mean distention scores as- disease without the need for duodenojejunal
signed to the duodenum, jejunum, proximal intubation (as is the case during enteroclysis)
ileum, distal ileum, and terminal ileum were a traumatic process that bypasses and thus
2.3, 2.3, 2.5, 2.7, and 2.6, respectively, for ob- precludes evaluation of the duodenum because
server 1 and 2.3, 2.1, 2.5, 2.6, and 2.6, respec-
tively, for observer 2 (Table 2). Interobserver
agreement was substantial ( = 0.73).
No morphologic abnormalities were de-
tected in nine (47%) of 19 examinations,
whereas pathologic lesions were identified in
10 (53%) of 19 examinations (Table 1). De-
tailed information regarding the abnormali-
ties detected is provided in Table 3 and some
are illustrated in Figures 38.
Discussion
The current study shows that MR SBFT us-
ing PEG as an oral contrast agent is feasible in
children with suspected small-bowel abnor-
malities, providing examinations within the
diagnostic range in the majority of cases. The
Fig. 2Coronal MR small-bowel follow-through
oral contrast medium was well tolerated in image in 6-year-old boy who had normal small bowel
84.2% of studies and moderately tolerated in shows excellent small-bowel distention.
A B
 MR Small-Bowel Follow-Through in Pediatric Patients

the tube tip is placed at the duodenojejunal

Cholangitis Lesion Muscle

or Fistula, (arbitrary units)
Sinus Tract Signal Intensity

Psoas

100

100
100
100
120

90

90

90
90
90
flexure [4]. The potential for duodenal evalua-
tion represents a significant advantage of MR
SBFT over enteroclysis techniques, resulting

200
200
200
220

160
180
190

180

170
170
in a significantly less traumatic experience in
a young patient [4].
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Abscess or

Sacroiliitis,
Phlegmon,

With advances in MR technology and

No

No
No

No
No

No
No

No

No
No

faster imaging sequences, MR SBFT with

SSFP imaging can be performed in seconds
with a short total imaging duration (average
proliferation, comb sign, free

proliferation, comb sign, free

proliferation, free fluid, skip

table time, 24 minutes). Previous studies by

fluid in pelvis, skip lesions

Laghi et al. [5, 8] described MR enterograph-

Separation, fibrofatty

Separation, fibrofatty
Separation, fibrofatty

Separation, fibrofatty
Separation, fibrofatty

Separation, fibrofatty

Separation, fibrofatty
Separation, fibrofatty
Extraluminal

ic techniques with HASTE sequences re-

Features

quiring a 20-second breath-hold in children

fluid in pelvis

with known Crohns and celiac disease. SSFP

proliferation

proliferation
proliferation
proliferation
proliferation

sequences are more advantageous in chil-

lesions
dren because they have a significantly short-

None
None

er acquisition time than HASTE sequences,

reducing the potential for respiratory or mo-
Dilatation Stricture

tion artifact. Furthermore, breath-holding is

Loop

No

No
No

No
No

No
No

No

No
No

not essential for diagnostic-quality imaging

with SSFP and thus the likelihood of a diag-
nostic examination is improved. Our study
Loop
Features

Yes
Yes

No

No
No
No
No

No

No
No

has shown that this short imaging duration is

well accepted and does not place excessive
demands on the ability of children to cooper-
Attenuated Superficial

Attenuated Superficial
Attenuated Superficial

Attenuated Superficial
Attenuated Superficial

Attenuated Superficial
Attenuated Superficial
Ulcers

ate and remain still.

None
Attenuated None

The approach of Laghi et al. [5, 8] was to

acquire images every 5 minutes for a maxi-
NoteL = length, TS = transverse section. Patient age is given at the time the examination was performed.
Attenuated

mum of 30 minutes until the cecum was ob-

TABLE 3: Imaging Findings in Examinations Showing Pathologic Findings

Fold

served to be filled by the oral contrast agent

[5], with occupation time of the scanner
room less than 40 minutes for each case [8].
Using the algorithm recommended by Lohan
Circumferential

Circumferential
Circumferential

et al. [7], the average number of visits to the

Circumferential

Circumferential
Circumferential

Circumferential
Circumferential

Circumferential
Mural

MR room was 1.3 in the current study, with

thickening

5 x 6 mm mass thickening
thickening
thickening

thickening

thickening
thickening

thickening
thickening

each visit lasting between 2 and 4 minutes.

Normal

This shorter table time optimizes MR ma-

chine usage and is likely more acceptable to
this age group because parent interaction
Indeterminate colitis, colon Whole colon
(L [cm] x TS)

> 35 1 cm
12 5 mm

25 1 cm

may then occur between sets of imaging.

7 3 mm

3.5 x 3 mm
10 x 6 mm,

12 x 3 mm,
5 x 6 mm,
Size

The overall bowel distentions were excel-

8 x 2 mm
8 x 6 mm

6 x 2 mm
9 mm

lent in the majority of cases and greater than

a score of 2 in 84%. The mean distention
scores were well within the diagnostic range
Diagnosis

Crohns ileum and terminal

Crohns ileum and terminal
Crohns ileum and terminal

Crohns ileum and terminal

Crohns ilium and terminal
Crohns ileum and terminal

Possible Crohns ileum or

Crohns ileum, phlegmon

in all small-bowel segments for both observ-

Crohns terminal ilium

ers, with a substantial degree of interobserver

mass, terminal ilium
ilium, skip lesions
Location

adhesions, ileum

agreement in score assignment ( = 0.73).

Inflammatory bowel disease is not a rare
small-bowel condition in the pediatric popu-
lation. Investigation for suspected Crohns
ilium
ilium

ilium
ilium

ilium

disease and follow-up of known disease were

the main indications in the current patient
Age
No. Sex (y)

13

17
17

16

17
13

16

17

15
15

population. Jaffe et al. [9] reported that the av-

erage number of conventional SBFT (effective
M
M
M

F
F

F
F

dose, 1.373.83 mSv) and CT examinations

Patient

(effective dose, 16.1 mSv) in Crohns disease

6

8
3

5
2

2
1

patients was 1.8 and 2.3, respectively, with 9%

AJR:192, May 2009 1243


(34/373) of patients undergoing in excess of
five CT examinations and 3% (11/373), more
than 10 CT examinations. The availability of
a reproducible, accurate, sensitive technique
without the need for ionizing radiation expo-
sure may have huge implications for pediatric
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A B
A B
A B
1244 AJR:192, May 2009
Cronin et al.
patients with inflammatory bowel disease,
with the potential for overall reduction in cu-
mulative lifetime radiation exposure.
In conclusion, MR SBFT is an emerging
technique that is of proven benefit in evaluat-
ing the adult patient with suspected small-
bowel abnormality. We show that MR SBFT
is feasible in the pediatric population because
it has the capability of rapidly providing stud-
ies of high diagnostic quality without the need
for duodenojejunal intubation, patient seda-
tion, or ionizing radiation exposure.
Fig. 416-year-old girl with Crohns disease.
A and B, Coronal MR small-bowel follow-through
(SBFT) images from diagnosis (A) and follow-up
6 months later (B) show excellent small-bowel
distention. This patient had progressive symptoms at
intervals. Both images show terminal ileal thickening
(straight arrows, A), comb sign (curved arrow), and
separation of bowel loops. Follow-up MR SBFT image
(B) shows persistent bowel-wall thickening and comb
sign separation; however, disease process is now
more extensive with further skip lesion in jejunum
(straight arrows, B).
Fig. 517-year-old girl who presented
with symptoms of colitis, which was
confirmed at colonoscopy. Because
diagnosis was indeterminate colitis
at histology, MR small-bowel follow-
through (SBFT) was performed to
assess small bowel for involvement.
A and B, Coronal (A) and axial (B)
MR SBFT images show pancolitis
with diffuse thickening of colon wall
(arrows). Small bowel was found to
be normal on MR SBFT. Excellent
large- and small-bowel distention is
visualized at MR SBFT.
Fig. 615-year-old girl who presented
with intermittent diarrhea.
A and B, Patient was unable to
tolerate barium follow-through
examination, which was
nondiagnostic. She tolerated MR
small-bowel follow-through (SBFT)
moderately well, which showed
featureless dilated ileal loop of bowel
lateral to bladder (arrow on coronal
image [A] and on axial image [B]).
Moderate small-bowel distention is
visualized at MR SBFT.
 MR Small-Bowel Follow-Through in Pediatric Patients
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A B
Fig. 7MR small-bowel follow-through (SBFT) Fig. 816-year-old girl with history of Crohns disease who presented with exacerbation.
image of 16-year-old girl with Crohns disease shows A and B, Coronal MR small-bowel follow-through (SBFT) images show thickening of terminal ileum best seen in
thickening of ileum, located in center of pelvis (long A (curved arrows). There is inflammatory phlegmon adjacent to small-bowel disease (straight arrows), which is
arrows). Loops of small bowel proximal to this lesion seen on both coronal MR SBFT images. These images show moderate small-bowel distention at MR SBFT.
are dilated. Further thickening is seen in nondistended
loop of sigmoid colon (skip lesion), located in left side
of pelvis (short arrow). These images show moderate
small-bowel distention at MR SBFT.

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