Small bowel MRI for IBD

What is a small bowel MRI?

A small bowel magnetic resonance imaging (MRI) scan is an imaging procedure used to look at the small intestine (bowel) for inflammation, swollen lymph nodes, thickening or any other changes of the bowel wall. These changes could indicate Crohn’s disease.

It is a common procedure for those with inflammatory bowel disease (IBD) or suspected IBD.

What is an MRI? How does an MRI scan work?

MRIs are a way of generating a 3D image using a combination of powerful magnets and radio waves.

The big cylindrical tunnel you lie in is actually a very powerful magnet, which is used to obtain images of a target body part (in this case, the length of your small bowel).

Your body tissues contain water molecules which are comprised of hydrogen and oxygen ions. MRI scanners magnetise the protons at the centre of hydrogen ions, pulling them into alignment.

Then, short bursts of radio waves are used to knock the protons out of alignment. When these bursts are turned off, the protons in the water molecules line up again, which sends out a signal that is picked up by the machine.

This means that different types of body tissue (e.g. fat vs. muscle) emit different signals due to the speed of the protons realigning, which allows the radiography team to generate an image of the bowel based on the magnetic resonances picked up by the machine.

The information obtained from the signals can be used to produce a 3D representation of the body tissues, which radiologists use to identify inflammation or irregular thickening in the bowel.

Why am I being sent for a small bowel MRI?

There are multiple reasons you might be sent for a small bowel MRI scan. The five main reasons for a small bowel MRI are:

Diagnosis

When you are invited for a small bowel MRI, this will often be to make sense of symptoms or results from blood tests or stool tests. Together with the results from other tests, an MRI can inform a diagnosis of IBD.

To investigate the cause of changes in symptoms post-diagnosis

If you are experiencing new symptoms, such as nausea, vomiting, or weight loss, this can indicate a narrowing of the small bowel (such as a stricture). An MRI can help to identify strictures and reveal whether the stricture is the result of active inflammation or scar tissue.

New symptoms can also be the result of abnormal connections between different areas of bowel (fistulae). An MRI scan is the most effective way to determine which of the possible causes is responsible for the change in symptoms.

Monitoring treatment effectiveness

After an operation or new course of medication for your IBD, your doctor may want to check the treatment is having the intended effect on your Crohn's disease or ulcerative colitis by monitoring inflammation in your bowel.

To screen for strictures prior to video capsule endoscopy

Sometimes, doctors will use a procedure known as video capsule endoscopy or VCE (whereby a capsule containing a camera is swallowed to take photographs of the lining of the bowel. This is to look for ulcers and inflammation). A small bowel MRI may be conducted prior to the VCE to screen for any strictures or narrowings, because any narrowing in the bowel may cause the camera to get stuck. A small bowel MRI is therefore a useful way of ensuring the safety of the video capsule endoscopy procedure.

Prior to surgery

As with the VCE, sometimes a small bowel MRI will be carried out prior to surgical procedures on the bowel to check for any other areas of inflammation that may need surgery or other treatment.

Why might I have an MRI over an ultrasound or a colonoscopy?

An MRI has several advantages to alternative procedures.

Colonoscopy is an intrusive procedure, and while it is more sensitive than an MRI scan in detecting IBD, it only gives access to the large bowel and the end of the small bowel.

Meanwhile, ultrasound is the safest and most comfortable option, but it doesn’t provide information about the full length of the bowel.

MRI gives a more comprehensive view of the bowel, with a good degree of sensitivity and accuracy.

Sometimes you may need to have several different procedures or tests. The results from all of these will help form a picture of what is going on inside your body and help with a diagnosis of IBD or to monitor whether treatment is working.

Is a small bowel MRI safe?

Generally speaking, an MRI scan is considered to be a very safe procedure. However, there are some possible complications for patients with metal implants and pacemakers. Some also experience side effects caused by the MRI contrast medium which you may need to take for your small bowel MRI scan.

Is there a cancer risk with a small bowel MRI?

No. No X-rays are used so there is no exposure to radiation

MRI scans and metal

Since the machine itself is a very powerful magnet, you should avoid bringing metal into the scan with you
Non MRI-compatible safe implants, piercings or jewellery are at risk of shifting or moving while the scan is taking place
Many implants are MRI-compatible, so even for individuals with metal prosthetics, MRIs are a safe procedure
It is important that you speak to your radiographer about any implants before the scan takes place

Possible side effects of contrast solution

Before your MRI scan, you will be given approximately 500ml-1 litre of a contrast solution to drink to make your bowel more visible on the scan. This can cause nausea, vomiting, cramps, bloating and diarrhoea.
Patients are advised to drink plenty of water to avoid dehydration if you do experience diarrhoea or vomiting
It is advisable to bring a spare change of clothes in case of an adverse reaction to the drink

Risks associated with gadolinium contrast medium

As part of an MRI scan, a dye known as a gadolinium contrast medium will sometimes be injected into a patient’s veins (via a cannula in the arm) to improve the quality of the images in the scan
Gadolinium contrast medium is generally very safe
The injection of gadolinium contrast is usually painless, with no side effects
1-4 in 100 patients report a mild nausea, dizziness, or headache
In less than 100 patients, vomiting may occur
Less than 1 in 1000 patients experience an itchy skin rash on site of the injection (mild allergic reaction)
Approximately 1 in 10,000 patients may experience more severe allergic reactions (anaphylaxis) – which may include swelling of the lips and mouth and difficult breathing. Please inform your doctor if you have had allergic reactions to gadolinium in the past
NSF (nephrogenic systemic fibrosis) is a very rare complication associated with gadolinium when given to patients with kidney disease. It is therefore essential that you tell the radiology staff if you have any history of kidney disease
Recent studies have found that a small residue of the injected gadolinium can be retained in tissues. There are no known adverse side effects to this

Buscopan injection

A small dose of buscopan may be given through cannula in a vein in your arm (intravenous) halfway through the scan. This is to slow down bowel movement, and it can have some side effects
Some patients report blurred vision and are advised not to drive in this case. In rare instances, patients’ eyes can become reddened or painful. If this occurs, you should contact your GP immediately

MRI scans, gadolinium, and pregnancy

You will be asked to confirm that you are not pregnant before an MRI scan is conducted. In rare cases it will go ahead, if the scan is deemed to be important enough to outweigh the (small) risks
If you are pregnant or there is a possibility of pregnancy, you are unlikely to be given the gadolinium injection
It is safe to breast-feed after being given the gadolinium injection

MRI scans and cardiac pacemakers

The MRI machine may interact with a cardiac pacemaker
A risk-benefit analysis will be conducted prior to the scan, and if the risk of the MRI is deemed to be worth taking, your pacemaker will be switched to its MRI-safe mode by a cardiologist
If you do have a pacemaker, you should contact the MRI team ahead of your scan to make them aware and discuss your options