0:01

Okay, certainly looking at changes in the biliary

0:03

tract for Crohn's and UC is important.

0:07

Again, this isn't an enterography, but shows

0:10

some typical changes that we see with PSC and

0:15

things that you need to look out for, not just

0:17

liver evaluations, but also on MR angiographies.

0:21

And in this case, you see a lot of enhancement

0:23

in the region surrounding the biliary tree

0:26

that's associated with the inflammation

0:28

that is typically seen in cases of PSC.

0:31

It's not always present, but when it's present,

0:33

you can be pretty confident that that's what

0:34

you're dealing with, especially in a patient

0:36

at high risk with things like Crohn's or UC.

0:39

On the more delayed post-contrast images, what you'll

0:43

see are areas of decreased signal in kind of a linear

0:47

form that corresponds to the dilated peripheral ducts.

0:51

I often find this sequence is one of the more

0:53

helpful sequences because you can see very small

0:55

changes out in the periphery that can help you

0:58

detect these people that have some PSC where

1:00

they have that kind of peripheral dilation

1:02

and beaded appearance to their biliary tree.

1:06

And then certainly, as you all know, a key

1:08

sequence here is the T2 sequence where we can

1:12

identify areas of dilated ducts in the periphery.

1:16

I'm not going to show the MRCP sequences because you

1:19

don't typically have those for your enterographies.

1:21

So you need to be able to try to make the diagnosis

1:23

without looking at that classic MRCP look and use these

1:28

T2 and post-contrast images to make the diagnosis.

1:31

Of course, also look at the gallbladder for stones.

1:34

They can happen in anyone, as you know,

1:36

but there's a higher risk of occurring

1:39

in patients with UC and Crohn's.

1:42

And then don't forget to look at the

1:44

portal venous system because of the

1:46

risk of thrombosis in these cases.