Abstract
The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.
Highlights
Crohn’s disease is a chronic granulomatous inflammatory disorder of unknown etiology, characterized by transmural inflammation of the gastrointestinal tract
They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) being the modalities of choice for such evaluations
These methods have proved useful in the evaluation of the inflammatory activity of the disease, as long as specific protocols such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are followed for acquisition of images
Summary
Crohn’s disease is a chronic granulomatous inflammatory disorder of unknown etiology, characterized by transmural inflammation of the gastrointestinal tract. Lower voltage and amperage, which can reduce the doses of radiation without impeding the diagnostic performance of the examination, can be achieved through methods such as automatic dose modulation[11] Another strategy, based on the use of reconstruction algorithms that use iterative approaches, already available in many models of equipment from virtually all manufacturers, maintaining the image quality and reducing the dose by 35–72%(7,8,11), allows the examination to be made with an exposure of less than 2 mSv. CTE has the following advantages over MRE: it is more widely available; it takes less time and is more affordable; radiologists are generally more familiar with it; it is less susceptible to motion artifacts (including peristalsis); it has better spatial resolution; there is usually no need for sedation; and it is safe for patients with pacemakers or metallic implants. MRE should be considered for patients who have previously undergone
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