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Advances in Imaging of Inflammatory Bowel Disease

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Part of the book series: GI Surgery Annual ((GISA,volume 24))

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Abstract

Inflammatory bowel disease (IBD) which includes ulcerative colitis (UC) and Crohn’s disease (CD) is a chronic remitting, relapsing inflammatory disorder of uncertain aetiology, with a prevalence of 45 per million and an annual incidence of 6.1 per million population in India [1, 2]. There is a geographical variation, with UC being more common in northern India and CD being more common in the south. The burden of IBD may be higher than previously estimated and is rising [2–5].

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Acknowledgements

I would like to thank Dr. Archana Rastogi for providing pathological slides, Dr. Bharat Aggarwal for the conventional enteroclysis and MRE images and Ms. Komal Yadav for diligently collecting data and helping in editing. I would also like to acknowledge Dr. Senthil Kumar for his valuable suggestions and editing of the final manuscript.

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Authors and Affiliations

  1. Department of Radiology, Institute of Liver and Biliary Sciences, New Delhi, India

    Shalini Thapar Laroia

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  1. Shalini Thapar Laroia
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Editors and Affiliations

  1. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Peush Sahni

  2. Department of GI Surgery and Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India

    Sujoy Pal

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Editorial Comment

This article comprehensively describes the advances in imaging inflammatory bowel disease (IBD). Imaging plays a more crucial role in the evaluation of Crohn’s disease than in ulcerative colitis as the latter is well evaluated by colonoscopy. The problem is more challenging in India due to the high prevalence of intestinal tuberculosis which can mimic Crohn’s disease clinically, endoscopically, on imaging as well as histopathology. Imaging algorithms for IBD have undergone a paradigm shift over the past decade. Barium studies have fallen into disrepute as they provide only luminal information. Sonography coupled with colour Doppler and ultrasound contrast agents is emerging as a useful noninvasive tool. Cross-sectional enterography (including both CT and MR enterographies) has become the modality of choice for evaluation of the small bowel in Crohn’s disease and complements ileocolonoscopy. It plays a useful role in diagnosis, assessing the distribution of disease, classifying it into inflammatory, stricturing and fistulizing phenotypes, detecting complications and assessing the response to treatment. CT enterography is preferred when the patient presents for the first time, and it provides more consistent image quality. MR enterography (MRE) is preferred for all follow-up examinations and even as the first modality in children. It is also the modality of choice for evaluation of perianal fistula. The advantages of MRE include lack of ionizing radiation, multiple paradigms for lesion characterization, can assess bowel motility and is more reliable for distinguishing inflammatory from fibrotic strictures. Active Crohn’s disease is characterized by stratified enhancement of the bowel wall, T2 hyperintensity of the wall, engorged vasa recta manifested as comb sign, mesenteric inflammation and diffusion restriction in the wall. Unfortunately, all these features can also be seen in intestinal tuberculosis. The features which favour Crohn’s disease are long-segment involvement, multiple segments (>3) involved, asymmetric involvement and left colonic involvement. The most reliable feature which favours intestinal tuberculosis is the presence of necrotic lymphadenopathy. CT and MRE can provide vital information in the setting of IBD which can guide appropriate therapy and also assist in assessment of response to therapy.

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Laroia, S.T. (2018). Advances in Imaging of Inflammatory Bowel Disease. In: Sahni, P., Pal, S. (eds) GI Surgery Annual. GI Surgery Annual, vol 24. Springer, Singapore. https://doi.org/10.1007/978-981-13-0161-2_3

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  • DOI: https://doi.org/10.1007/978-981-13-0161-2_3

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