Current Status of CT, Magnetic Resonance, and Barium in Inflammatory Bowel Disease

Abstract

Over the last several years there has been an increasing interest and utilization of cross-sectional imaging techniques for evaluation of the bowel in inflammatory bowel disease (IBD), especially for Crohn’s disease. Cross-sectional imaging can evaluate the entire gastrointestinal tract, depict transmural and perienteric inflammation, detect complications such as fistulas and abscesses—which may be not be evident with techniques used to evaluate the mucosal surface—and assess other abdominal organs and structures. Both computed tomography (CT) and magnetic resonance (MR) have advantages and limitations, which must be understood to perform the most appropriate imaging test in any given clinical scenario. Barium fluoroscopic exams still maintain some advantages over the cross-sectional techniques, such as higher spatial resolution and the ability to examine bowel peristalsis and distension in real time. In this article we explain the clinical benefits and appropriate utilization of cross-sectional enterography, review the technique and performance of CT enterography (CTE) and MR enterography (MRE), and discuss the findings and approaches to interpretation. Finally, we highlight the advantages and role of fluoroscopic examinations.