Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

Abstract

Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD. Core tip: Imaging plays a key role in the diagnosis and lifelong evaluation of a patient with inflammatory bowel disease (IBD). Several imaging modalities are available, each with a unique set of risks and benefits when considering cost, anesthesia risk in the pediatric population, ionizing radiation, image quality, and availability. In this article, we review the imaging techniques

Diagnostic accuracy of ultrasonography in comparison with colonoscopy for diagnosing of ulcerative colitis

“…[2][3][4][5][6][7] This issue emphasizes the importance of a noninvasive and accurate diagnostic method in clinical practice. 3,8,9 None of the imaging modalities alone could qualify as gold standard for evaluation of all of the aspects of UC. [9][10][11] Ultrasonography in comparison with endoscopy is noninvasive, inexpensive, radiation free, easy to use, acceptable, repeatable and completely compatible with an ideal diagnostic method.…”

“…3,8,9 None of the imaging modalities alone could qualify as gold standard for evaluation of all of the aspects of UC. [9][10][11] Ultrasonography in comparison with endoscopy is noninvasive, inexpensive, radiation free, easy to use, acceptable, repeatable and completely compatible with an ideal diagnostic method. 12 Tran abdominal ultrasonography is useful for diagnosing of bowel wall thickness, the extent of inflammatory involvement and assessment of disease activity.…”

The role of intestinal ultrasound in diagnostics of bowel diseases

“…The machines used for sonographic evaluation of the gastrointestinal tract are no different than those used in standard radiology units. Nevertheless, the performance of intestinal ultrasound is dedicated to experienced sonographers, who are able to recognise and evaluate all bowel structures and their abnormalities [ 6 , 10 ]. The performance of bowel ultrasound involves the use of two different probes: low-frequency convex probe (3.0–3.5 MHz) and high-frequency linear probe (5–17 MHz) [ 11 ].…”

“…Over the past few years, thanks to technological progress in ultrasonography, followed by increasing experience of physicians, intestinal ultrasound has become an important diagnostic tool in the detection of bowel diseases. Being a safe, fast, inexpensive imaging method with high sensitivity and specificity, it is commonly used in European countries, such as Italy and Germany, especially for the diagnosis and monitoring of inflammatory bowel diseases (IBD) [ 1 – 6 ]. The performance of the intestinal ultrasound can be improved by the use of intraluminal or intravenous contrast media [ 4 , 7 , 8 ].…”

Application of machine learning algorithms for multiparametric MRI-based evaluation of murine colitis

“…Whilst computed tomography (CT) is a widely available and fast method, it lacks sensitivity in terms of detection of early mucosal changes, and is associated with the risks of repeated radiation exposure. Due to the technical progress of the last years, magnetic resonance imaging (MRI) has become the imaging modality of choice in detection, surveillance, therapy monitoring and evaluation of the extent of IBDs in humans [ 13 , 14 ]. However, bowel imaging in animal models remains challenging.…”