A step-by-step guide to ileoanal J-pouch MRI interpretation

Tech Coloproctol. 2023 Dec 8;28(1):2. doi: 10.1007/s10151-023-02888-x.

Abstract

Background: Multidisciplinary management of patients with an ileoanal pouch requires dedicated imaging to identify structural problems of the pouch associated with dysfunction. The purpose of this study is to provide a framework for interpretation of magnetic resonance imaging (MRI) scan of the ileoanal pouch to enable surgeons and radiologists to work cohesively, optimise diagnosis and ultimately improve patient care.

Methods: We propose a protocol for structured MRI assessment of the ileal pouch, aiming to provide surgeons a systematic report of the anatomy, its variations and pouch complications. This guide consists of studying the characteristics of the bowel, mesentery and anal canal.

Results: The presented checklist is designed to systematically interpret and identify abnormalities of the ileoanal pouch on MRI. It focuses on the characteristics of the bowel (encompassing pre-pouch ileum, pouch and rectal cuff), mesentery and anal canal. The different elements of the checklist are presented in the associated supplementary video.

Conclusions: A combination of clinical assessment, endoscopic evaluations and imaging is fundamental to achieving accurate diagnosis of ileoanal pouch surgery complications and pouch dysfunction.

Keywords: Ileoanal pouch surgery; Inflammatory bowel disease; Magnetic resonance imaging.

MeSH terms

  • Anal Canal / diagnostic imaging
  • Anal Canal / surgery
  • Colitis, Ulcerative* / surgery
  • Colonic Pouches* / adverse effects
  • Humans
  • Ileum / surgery
  • Magnetic Resonance Imaging
  • Postoperative Complications / surgery
  • Proctocolectomy, Restorative* / adverse effects
  • Proctocolectomy, Restorative* / methods
  • Rectum / surgery