MR Imaging Findings of Small Bowel Hemorrhage: Two Cases of Mural Involvement and One of Perimural

Abstract

Purpose: To demonstrate the MR appearance of small bowel wall hemorrhage. Materials and Methods: A search was performed of the clinical information system (CIS) and the abdominal MRI databases of our institution for patients diagnosed with bowel hemorrhage on MRI between January 1, 2000, and July 31, 2008. All patients were imaged using a protocol that included noncontrast T1-and T2-weighted images and postgadolinium gradient echo images. Results: Two male patients, 44 and 55 years of age, were identified with small bowel mural hemorrhage, one in the duodenum and one in the jejunum. A third patient, a 66-year-old man, was identified with perimural hematoma. The following imaging features were observed: for mural hemorrhage, mural-based increased signal intensity (SI) in the bowel wall on fat suppressed T1-weighted images, vari- able increased SI on T2-weighted images and no apprecia- ble enhancement on the postcontrast T1-weighted image; perimural hemorrhage exhibited normal thickness low SI wall on T2-weighted single shot images, with ill-defined material surrounding the bowel. SI features of this mate- rial, was similar to mural-based abnormality. Conclusion: In two patients with small bowel wall hemor- rhage, the wall showed increased thickness with increased SI on noncontrast T1-weighted images and lack of en- hancement on postgadolinium images. Perimural hema- toma showed an intact normal thickness wall that was low SI on T2 with surrounding material that was high SI on noncontrast T1-weighted images and did not enhance. © 2009.