Radiology in the current assessment of ulcerative colitis

Abstract

Abstract. Plain abdominal radiography in acute ulcerative colitis is essential to detect acute colonic complications, such as acute dilatation and free perforation. Sealed perforations may not be detected. Useful information can be gained as to the extent and severity of the mucosal lesions, but can be unreliable so that a contrast examination is required. The double contrast barium enema is more accurate than the single contrast study in revealing the early mucosal lesions of colitis. It is the examination of choice to show the extent and severity of disease, and is of considerable value in the differential diagnosis of colitis. In active colitis, the unprepared double contrast barium enema is recommended. The success of the examination relies on the absence of fecal residue adjacent to an active mucosa. The technique, uses, and limitations of this type of examination are described.In the long-term management of colitis, the role of radiology is to show the presence of extensive disease, which indicates an increased risk of malignancy. Lesions such as strictures or polyps may be found and are more likely to be benign than malignant, but confirmation often requires endoscopic biopsy. In the search for malignancy regular barium enema examination is not recommended, as this can only reveal an overt tumor, whereas premalignancy can be detected histologically from an endoscopic biopsy.

Plain X-Ray Films and Air Enema Films Reflect Severe Mucosal Inflammation in Acute Ulcerative Colitis

“…Almost all (32/33) dehaustrated segments had, however, endo scopically confirmed inflammation. This is in agreement with the observation that during an acute attack of ulcer ative colitis a tubular appearance of the colon or colonic shortening will not interfere with the evaluation of lesion extent [9], We stress that our results are valid for patients with an established diagnosis of ulcerative colitis, and that air ene ma X-ray, like the 'instant' double-contrast barium ene ma X-ray [3], should not be relied upon where the diagno sis is in doubt. In those cases colonoscopy is required.…”

“…16] and because haustra in the left colon can be obliterated by gaseous disten sion [3] or may normally be lacking below the splenic flexure [12,17].…”

“…The haustral pattern changes from deep and narrow to shallow and wide haustra and finally to complete dehaustration [3], Plain abdominal X-ray films can diagnose complica tions such as colonic dilatation and perforation, but can also give some information concerning the extent and severity of the mucosal inflammation present [4][5][6][7][8][9][10]. An unprepared 'instant' barium enema has been proposed in order to obtain more detailed information of the mucosal state [3,6,11,12]. Double-contrast barium enema and colonoscopy are laborious and can be dangerous, although colonoscopy is now considered to be safe [13,14], An alternative in the acute situation is investigation using air enema X-ray [10,15].…”

“…In ulcerative colitis, the mucosal changes follow a tran sition from fine granularity to deep ulceration [1][2][3]. The haustral pattern changes from deep and narrow to shallow and wide haustra and finally to complete dehaustration [3], Plain abdominal X-ray films can diagnose complica tions such as colonic dilatation and perforation, but can also give some information concerning the extent and severity of the mucosal inflammation present [4][5][6][7][8][9][10].…”

Severe Inflammatory Bowel Disease: Medical Management

“…Complete absence of residue suggests total colitis [3]. The extent of both small and large bowel gas increases with severity of colitis and the presence of excessive small bowel gas is a poor prognostic indicator [4]. However, in up to 50% of patients, insufficient gas is present to outline the colon.…”