Imaging of the Colon in Inflammatory Bowel Disease: Ready for Prime Time?

Abstract

Endoscopy is currently considered the reference standard for the evaluation of disease activity and severity in patients with inflammatory bowel disease (IBD). However, information provided by endoscopy is limited to the mucosal surface and cannot always be complete. Cross-sectional imaging techniques are gaining acceptance for the assessment of patients with Crohn's disease (CD) and ulcerative colitis (UC). Overall diagnostic accuracy of ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of colonic lesions in patients with IBD is high. The main limitation of US is its high dependence on expertise of the examiner and the anatomic location of lesions, and its main strengths are wide availability safety and low cost. CT is highly accurate for the evaluation of patients with IBD, but due to safety issues related to radiation exposure this technique should be reserved for urgent situations in which US is not diagnostic. Technological advances in the area of MRI have allowed optimization for the assessment of patients with IBD, mainly CD. Available evidence suggests that magnetic resonance colonography (MRC) has a high diagnostic accuracy for the detection of disease activity, location, severity, and complications, particularly for penetrating and stricturing lesions, characteristic of CD. MRC can provide a valuable guidance for performing medical and surgical treatment with maximized efficacy and safety. Overall, MRI findings accurately reflect disease activity and provide reliable information for decision-making and patient care optimization.

Bowel Ultrasonography in Inflammatory Bowel Disease

“…Even though there is low specificity for differentiating UC from other causes of bowel inflammation, sensitivity of detection of chronic inflammation in the colon has been reported to be up to 90% [22,38,39]. A few studies addressed the accuracy of ultrasonography in UC [40], sensitivities ranged from 48 to 100% and specificities from 82 to 90%. Sensitivity is higher in the sigmoid and descending colon with a sensitivity up to 97% [22], but low for rectal disease (15%) [8].…”

Enterography CT without and with water enema in patients with Crohn’s disease: Results from a comparative observational study in comparison with endoscopy

“…Recently, Ordas et al [26] have evaluated the role of the imaging (Ultrasonography US, CT and MRI) in patients with colonic inflammatory disease. The main limitation of US is its high dependence on expertise of the examiner and the anatomic location of lesions, and its main strengths are wide availability safety and low cost.…”

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

“…Regarding the transverse colon, a complete evaluation is difficult to obtain due to the variable anatomy. The rectum and the anus cannot be properly assessed due to the pelvic location [20,21]. While the terminal ileum is almost always visible, the jejunum and proximal ileum cannot be visualized entirely [22,23].…”