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Pain Imaging pp 347-363 | Cite as

Chronic Inflammatory Bowel Disease

  • Emilio QuaiaEmail author
Chapter

Abstract

Chronic inflammatory bowel disease includes Crohn’s disease (CD) and ulcerative colitis (UC). Abdominal pain represents a very common symptom and a fundamental parameter to grade disease inflammatory activity in patients with CD. Besides number of daily stool, the Crohn’s disease activity index (CDAI) is based on patient’s grade of abdominal pain and discomfort. CD clinical subtypes correspond to inflammatory disease, stricturing disease, and penetrating disease, and all of them can determine patient’s pain. Computed tomography (CT) and magnetic resonance imaging (MRI) are extremely sensitive in detecting mural inflammation, while they are less accurate in detecting mural fibrosis, both leading to bowel lumen stricture. MR imaging presents the highest diagnostic accuracy in determining the source of pain in patients with CD. Mural inflammation is the most common cause of pain, while crampy abdominal pain due to small bowel stricture represents the most common presenting symptom leading CD patients to the emergency unit. Lumen stricture is usually managed by pharmacologic therapy when stricture is determined by mural inflammation, while surgery is more appropriate for those strictures related to mural fibrosis. The third cause of pain in patients with CD are fistulas, mainly enteroenteric, perianal, and enterocutaneous, which can be easily detected by MR imaging due to the concomitant inflammatory reaction.

Keywords

Crohn’s disease Inflammation Bowel Ultrasonography Computed tomography Magnetic resonance imaging 

Supplementary material

Video 18.1a

(af) Active inflammatory disease in a patient with active Crohn’s disease. T1-w FFE MR imaging sequences on transverse (a). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 1636 kb)

Video 18.1b

(af) Active inflammatory disease in a patient with active Crohn’s disease. T1-w FFE MR imaging sequences on coronal plane (b). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 1541 kb)

Video 18.1c

(af) Active inflammatory disease in a patient with active Crohn’s disease. T2-w fat suppressed SPAIR sequences on coronal plane (c). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 6405 kb)

Video 18.1d

(af) Active inflammatory disease in a patient with active Crohn’s disease. T2-w fat suppressed SPAIR sequences on contrast-enhanced T1-w THRIVE MR imaging sequences on transverse (d). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 5593 kb)

Video 18.1e

(af) Active inflammatory disease in a patient with active Crohn’s disease. T2-w fat suppressed SPAIR sequences on contrast-enhanced T1-w THRIVE MR imaging sequences on transverse (e). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 4906 kb)

Video 18.1f

(af) Active inflammatory disease in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (f). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 7845 kb)

Video 18.1g

T1-w THRIVE MR imaging sequences on coronal planes (g). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 7845 kb)

Video 18.1h

T1-w THRIVE MR imaging sequences on coronal planes (h). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 7845 kb)

Video 18.1i

T1-w THRIVE MR imaging sequences on coronal planes (i). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 7845 kb)

Video 18.1j

T1-w THRIVE MR imaging sequences on coronal planes (j). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 3380 kb)

Video 18.1k

T2-w TSE MR imaging sequences on transverse plane (k). Two adjacent ileal loops reveal layered enhancemet on arterial phase with evidence of comb sign. The contemporary involvement of two adjacent ileal loops and the evidence of comb sign represent a specific sign of active disease. (AVI 3028 kb)

Video 18.2a

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w FFE MR imaging sequences on transverse (a). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 1949 kb)

Video 18.2b

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w FFE MR imaging sequences on coronal plane (b). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 1541 kb)

Video 18.2c

Enteroenteric fistula in a patient with active Crohn’s disease. T2-w fat-suppressed SPAIR sequences on coronal plane (c). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 6405 kb)

Video 18.2d

Enteroenteric fistula in a patient with active Crohn’s disease. T2-w fat-suppressed SPAIR sequences on contrast-enhanced T1-w THRIVE MR imaging sequences on transverse (d). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 5593 kb)

Video 18.2e

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (e). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 9005 kb)

Video 18.2f

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (f). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 11255 kb)

Video 18.2g

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (g). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 11255 kb)

Video 18.2h

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (h). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 11255 kb)

Video 18.2i

Enteroenteric fistula in a patient with active Crohn’s disease. T1-w THRIVE MR imaging sequences on coronal planes (i). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 4225 kb)

Video 18.2j

Enteroenteric fistula in a patient with active Crohn’s disease. T2-w TSE MR imaging sequences on transverse plane (j). Enterocolic fistula (star-like sign) is visualized close to the terminal ileal loop. This represents a specific sign of active disease. (AVI 3028 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of Padova Via Giustiniani 2PadovaItaly

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