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Technology Insight: new techniques for imaging the gut in patients with IBD

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 154–161 (2008)Cite this article

Abstract

Advances in techniques for imaging the gut continue to drive the rapid development of modalities for diagnosing and assessing the activity of IBD. Abdominal ultrasound and magnetic resonance enterography have shown great potential for the diagnosis of IBD and assessment of its distribution, with the benefit of avoiding radiation exposure and serving as a safe option for pregnant patients. CT enterography or CT enteroclysis, with neutral or negative contrast, seems to be a sensitive and specific modality for detecting disease in the small bowel. The role of CT or magnetic resonance colonography in patients with IBD remains uncertain and these modalities are now best reserved for patients who decline or cannot undergo standard endoscopic evaluations. Capsule endoscopy might be the most sensitive modality for the detection of mucosal small bowel disease, but its specificity remains in question. Double-balloon endoscopy is an exciting new tool that has the distinct advantage of enabling biopsy or treatment of lesions detected during the procedure. All these techniques are at the forefront of the rapidly evolving field of imaging the gut in patients with IBD.

Key Points

  • New imaging techniques continue to provide enhanced diagnostic capabilities in patients with IBD

  • Abdominal ultrasound seems to be an inexpensive, noninvasive modality for the evaluation of bowel disease, particularly in the terminal ileum

  • CT enterography and enteroclysis are sensitive and specific for detecting small bowel and extraintestinal disease manifestations

  • MRI provides both luminal and extraluminal information as an ionizing-radiation-free alternative to CT imaging

  • Capsule endoscopy is an extremely sensitive tool, potentially reducing its specificity

  • Double-balloon endoscopy can directly evaluate the entire small bowel and treat encountered abnormalities

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Figure 1: CT enterography of the abdomen in a patient with IBD.
Figure 2: Magnetic resonance enterography of the abdomen in a patient with Crohn's disease.
Figure 3: Capsule endoscopy visualizing an ulcer in the terminal ileum of a patient with suspected Crohn's disease.

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Authors and Affiliations

  1. DH Bruining is an Instructor of Medicine at the Mayo Clinic College of Medicine, Rochester, MN, USA, and a Gastroenterology Fellow at the Miles and Shirley Fiterman Center for Digestive Diseases at Mayo Clinic, Rochester.,

    David H Bruining

  2. EV Loftus Jr is Professor of Medicine at the Mayo Clinic College of Medicine and a Consultant at the Miles and Shirley Fiterman Center for Digestive Diseases.,

    Edward V Loftus Jr

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  1. David H Bruining
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Correspondence to Edward V Loftus Jr.

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Competing interests

EV Loftus, Jr is a consultant for Abbott, Elan, PDL Biopharma, Procter & Gamble, Salix, Shire and UCB, and has received grant/research support from Abbott, PDL Biopharma, Procter & Gamble, Schering-Plough, and UCB. DH Bruining declared no competing interests.

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Bruining, D., Loftus, E. Technology Insight: new techniques for imaging the gut in patients with IBD. Nat Rev Gastroenterol Hepatol 5, 154–161 (2008). https://doi.org/10.1038/ncpgasthep1028

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