Abstract
This review summarizes the role of imaging methods in treatment of inflammatory bowel diseases. Although endoscopy is the gold standard, it is sometimes incomplete, considerably invasive, and it has a greater rate of complications.
Therefore, imaging methods have been increasingly employed for diagnosis and monitoring of the disease. Nowadays CT and MR enterography/enteroclysis are preferred.
Compared to endoscopy, their main advantage is that they are comparatively safer and they depict the entire small and large bowel including the bowel wall and extraintestinal structures - penetrating lesions and extraintestinal complications. Enteroclysis has been a traditional method for visualisation of the small bowel.
In Crohn's disease, fluoroscopy has been gradually replaced by cross-sectional imaging methods that offer better results. MR has the advantage of absence of ionizing radiation, while CT enterography can be performed with a radiation dose similar or lower compared to enteroclysis.
Ultrasound is the first-line investigation method and it can be performed repeatedly. However, ultrasound image of inflammatory bowel disease may be incomplete.
In acute cases, routine CT of abdomen and pelvis (but not CT enterography) may be indicated apart from ultrasound and abdominal radiograph. CT colonography and barium enema have limited use in inflammatory bowel disease; they are reserved to search for colonic polyps and tumours.
In this indication, the diagnostic performance of CT colonography is comparable to optical colonoscopy. Imaging methods have their sensitivity and specificity and should be regarded as another piece of information about patient's disease together with history, clinical and laboratory assessment, endoscopy, and histology.
The synergy of radiology and gastroenterology depends to a great extent on knowledge, proficiency, and motivation of specialists from both sides.