0:01

So here's a nice example from an earlier case,

0:03

but this is a really great case to show what

0:05

acute inflammation is supposed to look like.

0:07

And in this case, when we look at our

0:11

T2 sequences, we immediately notice

0:14

there's a substantial amount of edema.

0:16

This bowel wall is clearly brighter

0:18

than the adjacent skeletal muscle.

0:20

It's an edematous appearance as

0:22

expected with acute inflammation.

0:24

Additionally, on the enhancement piece,

0:27

we see some findings that also indicate

0:29

that there's some acute inflammation.

0:30

First of all, we see enhancement not just of the

0:33

wall, but extending to the fat surrounding the

0:35

wall of the terminal ileum and ascending colon.

0:39

That clearly indicates there's

0:40

some degree of acute inflammation.

0:42

Additionally, I believe that several portions

0:46

of this highly inflamed bowel look ulcerated.

0:48

You kind of see divots and defects

0:51

extending into the lumen of the wall

0:53

of the bowel.

0:54

And that ulcerated appearance is highly

0:56

specific for an acute inflammatory process.

0:59

However, there could still be

1:00

a chronic fibrotic process.

1:02

So we want to also look at that.

1:04

And to do that, I think looking at our

1:07

delayed enhancement pattern is important.

1:09

And so this is our early phase, a little

1:11

bit of motion, but you can really see

1:13

that there's a lot of inflammation.

1:15

It's a lot more enhancing than the adjacent bowel.

1:18

When we look at the more delayed phase,

1:20

that degree of hyper enhancement is

1:21

if anything, dialed down a little bit.

1:24

It's not as stark.

1:25

It's clearly still hyper enhancing,

1:27

but it's not as stark as before.

1:29

So, because it didn't increase by a substantial

1:32

amount on that seven-minute images,

1:34

it wouldn't meet the criteria to say that it's

1:36

got increased seven-minute enhancement, which

1:38

would indicate a chronic process on top of it.

1:41

So there's clearly acute inflammation in this

1:42

case, and it's probably predominantly,

1:45

if not entirely, an acute inflammatory process.

1:48

And so the management for this case is not surgical.

1:50

They want to do something to improve

1:53

the immunologic milieu for this patient.

1:56

And so something like steroids or Infliximab or

1:59

some sort of type of drug is going to be what

2:03

the gastroenterologist is going to need to tame

2:05

this down and, and improve the patient's symptoms.