Intest Res.  2021 Oct;19(4):365-378. 10.5217/ir.2020.00097.

Crohn’s disease at radiological imaging: focus on techniques and intestinal tract

• Cicero G
• Mazziotti S

• KMID: 2521600
• DOI: http://doi.org/10.5217/ir.2020.00097

Abstract

Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn’s disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn’s disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.

Keyword

Crohn disease; Fluoroscopy; Ultrasound; Computed tomography; Magnetic resonance imaging

Figure

• 

  Fig. 1. A 34-year-old female patient affected by Crohn’s disease. (A) Barium follow-through photo shows dilation of the gastric lumen (asterisk) with obstruction at the level of the gastric antrum (arrowheads) and distention of duodenal lumen downstream (thin arrow). Coronal B-FFE (B) and axial HASTE T2-weighted (C) confirmed the gastric stenosis caused by a severe thickening of the gastric antrum (thick arrows). B-FFE, balanced-fast field echo; HASTE, half-Fourier acquisition single-shot turbo-spin-echo.

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  Fig. 2. A 46-year-old female Crohn’s disease patient with previous radical colectomy and ileorectal anastomosis. Water-soluble contrast colonic enema (A) showed a fistulous communication (arrow) with an adjacent ileal loop (asterisk), as confirmed in the axial computed tomography-scan maximum intensity projection reconstruction (B).

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  Fig. 3. A 17-year-old male patient was hospitalized for pain in the right iliac fossa. Ultrasound B-mode examination (A) showed a thickened last ileal loop (8 mm) with increased vascular signals at color-Doppler (B) and enlarged lymph nodes within the adjacent adipose tissue (C) due to inflammation. The following magnetic resonance enterography confirmed bowel wall thickening (arrows), as visible at coronal HASTE (D), axial HASTE (E) and axial diffusion-weighted imaging (F). HASTE, half-Fourier acquisition single-shot turbo-spin-echo.

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  Fig. 4. A 71-year-old male Crohn’s disease patient. Coronal computed tomography (CT)-enterography scans at different levels (A, B) and magnetic resonance enterography coronal HASTE images (C, D) show wall thickening within the gastric antrum (arrows) and the last ileal loop (arrowheads). Volume-rendering reconstruction (E) is a CT-scan useful tool in providing an overview of the intestinal loops dilation and stenotic points. HASTE, half-Fourier acquisition single-shot turbo-spin-echo.

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  Fig. 5. A 37-year-old female Crohn’s disease patient. Axial (A) and coronal-oblique (B) computed tomography-scan images show a perianal abscess (arrows) within the left ischioanal fossa. Perianal magnetic resonance imaging confirmed the presence of the abscessual collection at axial-oblique SPAIR (C). The axial-oblique HASTE (D) and diffusion-weighted imaging (E) scans, obtained at a more cranial level, show the trans-sphincteric communication with the anal canal located at 3 o’clock (arrowhead). SPAIR, spectral adiabatic inversion recovery; HASTE, half-Fourier acquisition single-shot turbo-spin-echo.

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