Imaging in inflammatory bowel disease: current and future perspectives

Abstract

The use of cross-sectional imaging and ultrasonography has long complemented endoscopic assessment of inflammatory bowel disease (IBD). Clinical symptoms alone are often not enough to assess disease activity, so a reliance on non-invasive techniques is essential. In this paper, we aim to examine the current use of radiological modalities in aiding the management of patients with IBD. We focus on the various sections of the gastrointestinal tract and how different modalities can aid in assessing current disease state and response to treatments. We also have a look at how newer sequences in cross-sectional imaging and ultrasonography can allow for better differentiation of disease activity (ie, fibrotic vs inflammatory) as well improve evaluation of small bowel, colonic and perianal disease. Furthermore, we examine how advanced image processing has the potential to allow radiology to be a surrogate for biomarkers. An example of this is explored when reviewing the ability of MR sequences to quantify visceral fat, which potentially plays a role in determining disease activity in Crohn’s disease. Lastly, we look into the expected role for artificial intelligence to be used as an adjunct to radiology to better improve IBD evaluation.

A multiparametric alternative to short inversion‐time inversion recovery for imaging inflammation: T2water and fat fraction measurement using chemical shift–encoded turbo spin‐echo MRI

“…2,3,16 Similar difficulties can exist in inflammatory diseases affecting other tissues. 6 Here, we propose the use of TSE Dixon acquisitions with incrementally increasing effective TEs to separate or "disentangle" T 2water and FF, thus providing a more objective method for the assessment of inflammation, which is less prone to misinterpretation due to these overlapping processes.…”

“…2,3,4,5 Additionally, MRI is used widely for imaging inflammation in other tissues, such as bowel, where the pathophysiology and imaging features share a number of common features with rheumatic diseases. 6 Conventional MRI for the assessment of bone and soft-tissue inflammation in these diseases primarily relies on T 2 -weighted short-inversion-time inversion-recovery (STIR) imaging. On STIR images, areas of hyperintensity indicate active inflammation, characterized by edema and cellular infiltration.…”

“…MRI has become a key component of pathways for diagnosing, phenotyping, and monitoring inflammation in rheumatic inflammatory diseases and is now used in standard care pathways in a number of diseases including spondyloarthritis, idiopathic inflammatory myositis, and juvenile idiopathic arthritis 2,3,4,5 . Additionally, MRI is used widely for imaging inflammation in other tissues, such as bowel, where the pathophysiology and imaging features share a number of common features with rheumatic diseases 6 …”

Impact of Obesity on the Course of Management of Inflammatory Bowel Disease—A Review

“…It gives another point of view on the idea of body mass in IBD patients. From this perspective, the assessment of nutritional status among these people should be obtained with more detailed procedures, e.g., bioelectrical impedance analysis [ 176 , 177 , 178 , 179 , 180 , 181 ].…”

Machine and deep learning in inflammatory bowel disease

“…Currently, the gold standard for IBD diagnosis is ileocolonoscopy and esophagogastroduodenoscopy (EGD) combined with histology analysis [3]; however, novel machine and deep learning technologies present promising new avenues to significantly enhance our understanding of IBD and optimize remission standards to aim for better patient outcomes. Additional diagnostic modalities, including capsule endoscopy, magnetic resonance enterography, and computed tomography enterography are becoming more common in aiding diagnosis and evaluation [4,5], and the data produced from these techniques can be analyzed by machine and deep learning models to inform management of disease (Fig. 1).…”