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Gastrointestinal Imaging

E2843. The Future of Inflammatory Bowel Disease Imaging: To Activity and Beyond

Porter K1,  Sanyal R1,  Robbin M1,  Malik T1,  Thomas J.1 1. University of Alabama at Birmingham, Birmingham, AL

Address correspondence to K. Porter (porterkk@gmail.com)

Background Information: Inflammatory bowel disease (IBD) includes two related but different chronic idiopathic diseases, Crohn disease (CD) and Ulcerative Colitis (UC). To date, imaging techniques have been used to assess inflammation in areas of bowel that are not readily accessible endoscopically; however, imaging has a much greater role to play in the diagnosis, and perhaps most importantly, in the monitoring of IBD. CD, in particular, is often transmural with patients developing fistulas and stenosis. Beyond evaluating disease unreachable by endoscopic visualization, cross-sectional imaging is fundamental in the management of patients with these transmural complications. In addition to anatomic information, including extent of active disease, new imaging techniques, such as DWI, dynamic enhanced MR, and ultrasound (US) and fusion imaging (PET-MR), radiologists can dissociate acute inflammatory changes from more chronic disease processes and assess alterations in the motility of the affected bowel. Furthermore, IBD is associated with a number of extra-intestinal sequela, which require advanced imaging for their characterization, such as primary sclerosing cholangitis and nephrolithiasis. New imaging techniques such as DWI, dynamic enhanced MR and US perfusion, and MR motility imaging have proven roles in improving the diagnosis, assessing the disease severity, and evaluating disease complications in IBD. As such, radiologists must be comfortable with the multimodality imaging appearance of IBD and its complications including these advanced MR and US techniques.

Educational Goals/Teaching Points: The goals of this exhibit are to illustrate the spectrum of complications related to IBD with MR, US (including enhanced US), and CT imaging, including acute inflammation, fibrostenotic strictures, fistulas, abscesses, and extra-intestinal sequela, and examine the response to treatment with illustrative examples. We will also discuss how to determine disease activity and distinguish inflammatory from fibrotic disease, including quantitation. We will review the management implications of this dissociation. Lastly, we will discuss protocol and technique optimization for advanced IBD imaging and imaging pitfalls.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: Imaging findings of IBD acute and chronic changes and complications, including US, CT, and MR will be performed through case examples. Additionally, quantitative methods for assessing extent of disease activity, including inflammatory and fibrotic burden, will be discussed.

Conclusion: Recognizing and accurately diagnosing abnormalities associated with IBD necessitates a command of the findings associated with active inflammation; however, to monitor and assist clinicians in the management of patients with IBD, an understanding of and comfort with the spectrum of findings on advanced imaging is also needed. Radiologists must be comfortable with the multimodality imaging appearance of IBD and its complications on advanced imaging, including DWI MR, PET-MR and perfusion MRI and US.