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Advances in Imaging of Inflammatory Bowel Disease

  • Shalini Thapar Laroia
Chapter
Part of the GI Surgery Annual book series (GISA, volume 24)

Abstract

Inflammatory bowel disease (IBD) which includes ulcerative colitis (UC) and Crohn’s disease (CD) is a chronic remitting, relapsing inflammatory disorder of uncertain aetiology, with a prevalence of 45 per million and an annual incidence of 6.1 per million population in India [1, 2]. There is a geographical variation, with UC being more common in northern India and CD being more common in the south. The burden of IBD may be higher than previously estimated and is rising [2–5].

Notes

Acknowledgements

I would like to thank Dr. Archana Rastogi for providing pathological slides, Dr. Bharat Aggarwal for the conventional enteroclysis and MRE images and Ms. Komal Yadav for diligently collecting data and helping in editing. I would also like to acknowledge Dr. Senthil Kumar for his valuable suggestions and editing of the final manuscript.

References

  1. 1.
    Ray G. Inflammatory bowel disease in India – past, present and future. World J Gastroenterol. 2016;22:8123–36.CrossRefGoogle Scholar
  2. 2.
    Singh P, Ananthakrishnan A, Ahuja V. Pivot to Asia: inflammatory bowel disease burden. Intest Res. 2017;15:138–41.CrossRefGoogle Scholar
  3. 3.
    Ahuja V, Tandon RK. Inflammatory bowel disease in the Asia-Pacific area: a comparison with developed countries and regional differences. J Dig Dis. 2010;11:134–47.CrossRefGoogle Scholar
  4. 4.
    Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.CrossRefGoogle Scholar
  5. 5.
    Khosla SN, Girdhar NK, Lal S, Mishra DS. Epidemiology of ulcerative colitis in hospital and select general population of northern India. J Assoc Physicians India. 1986;34:405–7.PubMedGoogle Scholar
  6. 6.
    Ye Y, Pang Z, Chen W, Ju S, Zhou C. The epidemiology and risk factors of inflammatory bowel disease. Int J Clin Exp Med. 2015;8:22529–42.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Jess T, Frisch M, Simonsen J. Trends in overall and cause-specific mortality among patients with inflammatory bowel disease from 1982 to 2010. Clin Gastroenterol Hepatol. 2013;11:43–8.CrossRefGoogle Scholar
  8. 8.
    Ananthakrishnan AN, Cagan A, Gainer VS, Cheng SC, Cai T, Szolovits P, et al. Mortality and extraintestinal cancers in patients with primary sclerosing cholangitis and inflammatory bowel disease. J Crohns Colitis. 2014;8:956–63.CrossRefGoogle Scholar
  9. 9.
    Freeman HJ. Inflammatory bowel diseases in Indo-Canadians with and without antineutrophil cytoplasmic autoantibodies. Can J Gastroenterol. 2000;14:21–6.CrossRefGoogle Scholar
  10. 10.
    Rajput HI, Seebaran AR, Desai Y. Ulcerative colitis in the Indian population of Durban. S Afr Med J. 1992;81:245–8.PubMedGoogle Scholar
  11. 11.
    Malhotra R, Turner K, Sonnenberg A, Genta RM. High prevalence of inflammatory bowel disease in United States residents of Indian ancestry. Clin Gastroenterol Hepatol. 2015;13:683–9.CrossRefGoogle Scholar
  12. 12.
    Gee MS, Harisinghani MG. MRI in patients with inflammatory bowel disease. J Magn Reson Imaging. 2011;33:527–34.CrossRefGoogle Scholar
  13. 13.
    Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369:1641–57.CrossRefGoogle Scholar
  14. 14.
    Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126:1504–17.CrossRefGoogle Scholar
  15. 15.
    Ahmad TM, Greer ML, Walters TD, Navarro OM. Bowel sonography and MR enterography in children. AJR Am J Roentgenol. 2016;206:173–81.CrossRefGoogle Scholar
  16. 16.
    Vavricka SR, Scharl M, Gubler M, Rogler G. Biologics for extraintestinal manifestations of IBD. Curr Drug Targets. 2014;15:1064–73.CrossRefGoogle Scholar
  17. 17.
    Taylor GA, Nancarrow PA, Hernanz-Schulman M, Teele RL. Plain abdominal radiographs in children with inflammatory bowel disease. Pediatr Radiol. 1986;16:206–9.CrossRefGoogle Scholar
  18. 18.
    Benchimol EI, Turner D, Mann EH, Thomas KE, Gomes T, McLernon RA, et al. Toxic megacolon in children with inflammatory bowel disease: clinical and radiographic characteristics. Am J Gastroenterol. 2008;103:1524–31.CrossRefGoogle Scholar
  19. 19.
    Livshits A, Fisher D, Hadas I, Bdolah-Abram T, Mack D, Hyams J, et al. Abdominal x-ray in pediatric acute severe colitis and radiographic predictors of response to intravenous steroids. J Pediatr Gastroenterol Nutr. 2016;62:259–63.CrossRefGoogle Scholar
  20. 20.
    Kishi T, Shimizu K, Hashimoto S, Onoda H, Washida Y, Sakaida I, et al. CT enteroclysis/enterography findings in drug-induced small-bowel damage. Br J Radiol. 2014;87:20140367.CrossRefGoogle Scholar
  21. 21.
    Murphy KP, McLaughlin PD, O’Connor OJ, Maher MM. Imaging the small bowel. Curr Opin Gastroenterol. 2014;30:134–40.CrossRefGoogle Scholar
  22. 22.
    Algin O, Evrimler S, Arslan H. Advances in radiologic evaluation of small bowel diseases. J Comput Assist Tomogr. 2013;37:862–71.CrossRefGoogle Scholar
  23. 23.
    Maconi G, Ardizzone S, Greco S, Radice E, Bezzio C, Bianchi Porro G. Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn’s disease. Am J Gastroenterol. 2007;102:2214–9.CrossRefGoogle Scholar
  24. 24.
    Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, et al. Bowel ultrasound and mucosal healing in ulcerative colitis. Dig Dis. 2009;27:285–90.CrossRefGoogle Scholar
  25. 25.
    Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis? A prospective study. Am J Gastroenterol. 2010;105:1150–7.CrossRefGoogle Scholar
  26. 26.
    Parente F, Greco S, Molteni M, Anderloni A, Bianchi Porro G. Imaging inflammatory bowel disease using bowel ultrasound. Eur J Gastroenterol Hepatol. 2005;17:283–91.CrossRefGoogle Scholar
  27. 27.
    Bolondi L, Gaiani S, Brignola C, Campieri M, Rigamonti A, Zironi G, et al. Changes in splanchnic hemodynamics in inflammatory bowel disease. Non-invasive assessment by Doppler ultrasound flowmetry. Scand J Gastroenterol. 1992;27:501–7.CrossRefGoogle Scholar
  28. 28.
    Maconi G, Imbesi V, Bianchi Porro G. Doppler ultrasound measurement of intestinal blood flow in inflammatory bowel disease. Scand J Gastroenterol. 1996;31:590–3.CrossRefGoogle Scholar
  29. 29.
    Chiorean L, Schreiber-Dietrich D, Braden B, Cui XW, Buchhorn R, Chang JM, et al. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World J Gastroenterol. 2015;21:5231–41.CrossRefGoogle Scholar
  30. 30.
    Girlich C, Jung EM, Iesalnieks I, Schreyer AG, Zorger N, Strauch U, et al. Quantitative assessment of bowel wall vascularisation in Crohn’s disease with contrast-enhanced ultrasound and perfusion analysis. Clin Hemorheol Microcirc. 2009;43:141–8.PubMedGoogle Scholar
  31. 31.
    Quaia E. Contrast-enhanced ultrasound of the small bowel in Crohn’s disease. Abdom Imaging. 2013;38:1005–13.CrossRefGoogle Scholar
  32. 32.
    Migaleddu V, Scanu AM, Quaia E, Rocca PC, Dore MP, Scanu D, et al. Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn’s disease. Gastroenterology. 2009;137:43–52.CrossRefGoogle Scholar
  33. 33.
    Romanini L, Passamonti M, Navarria M, Lanzarotto F, Villanacci V, Grazioli L, et al. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease. Eur J Radiol. 2014;83:1317–23.CrossRefGoogle Scholar
  34. 34.
    Ripollés T, Martínez MJ, Paredes JM, Blanc E, Flors L, Delgado F. Crohn disease: correlation of findings at contrast-enhanced US with severity at endoscopy. Radiology. 2009;253:241–8.CrossRefGoogle Scholar
  35. 35.
    De Franco A, Di Veronica A, Armuzzi A, Roberto I, Marzo M, De Pascalis B, et al. Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity. Radiology. 2012;262:680–8.CrossRefGoogle Scholar
  36. 36.
    Quaia E, De Paoli L, Stocca T, Cabibbo B, Casagrande F, Cova MA. The value of small bowel wall contrast enhancement after sulfur hexafluoride-filled microbubble injection to differentiate inflammatory from fibrotic strictures in patients with Crohn’s disease. Ultrasound Med Biol. 2012;38:1324–32.CrossRefGoogle Scholar
  37. 37.
    Kucharzik T, Kannengiesser K, Petersen F. The use of ultrasound in inflammatory bowel disease. Ann Gastroenterol. 2016;30:135–44.PubMedPubMedCentralGoogle Scholar
  38. 38.
    Harley NH, Chittaporn P, Heikkinen MS, Meyers OA, Robbins ES. Radon carcinogenesis: risk data and cellular hits. Radiat Prot Dosim. 2008;130:107–9.CrossRefGoogle Scholar
  39. 39.
    Brenner DJ, Elliston CD, Hall EJ, Berdon WE. Estimates of the cancer risks from pediatric CT radiation are not merely theoretical: comment on ‘point/counterpoint: in x-ray computed tomography, technique factors should be selected appropriate to patient size. against the proposition’. Med Phys. 2001;28:2387–8.CrossRefGoogle Scholar
  40. 40.
    Duigenan S, Gee MS. Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol. 2012;199:907–15.CrossRefGoogle Scholar
  41. 41.
    Rice HE, Frush DP, Farmer D, Waldhausen JH, APSA Education Committee. Review of radiation risks from computed tomography: essentials for the pediatric surgeon. J Pediatr Surg. 2007;42:603–7.CrossRefGoogle Scholar
  42. 42.
    Robbins E, Meyers PA. Ionizing radiation: an element of danger in every procedure. Pediatr Blood Cancer. 2010;55:397–8.CrossRefGoogle Scholar
  43. 43.
    Pascu M, Roznowski AB, Müller HP, Adler A, Wiedenmann B, Dignass AU. Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis. 2004;10:373–82.CrossRefGoogle Scholar
  44. 44.
    Kinkel H, Michels G, Jaspers N. Value of ultrasound in diagnostic and follow-up of chronic inflammatory bowel diseases. Dtsch Med Wochenschr. 2015;140:46–50.CrossRefGoogle Scholar
  45. 45.
    Herfarth H, Palmer L. Risk of radiation and choice of imaging. Dig Dis. 2009;27:278–84.CrossRefGoogle Scholar
  46. 46.
    Yoshida A, Ueno F, Morizane T, Joh T, Kamiya T, Takahashi S, et al. Asian perspectives on diagnostic and therapeutic strategies in inflammatory bowel disease: report and analysis of a survey with questionnaires. Digestion. 2017;95:79–88.CrossRefGoogle Scholar
  47. 47.
    Raptopoulos V, Schwartz RK, McNicholas MM, Movson J, Pearlman J, Joffe N. Multiplanar helical CT enterography in patients with Crohn’s disease. AJR Am J Roentgenol. 1997;169:1545–50.CrossRefGoogle Scholar
  48. 48.
    Lee CH, Goo JM, Ye HJ, Ye SJ, Park CM, Chun EJ, et al. Radiation dose modulation techniques in the multidetector CT era: from basics to practice. Radiographics. 2008;28:1451–9.CrossRefGoogle Scholar
  49. 49.
    Yu L, Bruesewitz MR, Thomas KB, Fletcher JG, Kofler JM, McCollough CH. Optimal tube potential for radiation dose reduction in pediatric CT: principles, clinical implementations, and pitfalls. Radiographics. 2011;31:835–48.CrossRefGoogle Scholar
  50. 50.
    Kaza RK, Platt JF, Al-Hawary MM, Wasnik A, Liu PS, Pandya A. CT enterography at 80 kVp with adaptive statistical iterative reconstruction versus at 120 kVp with standard reconstruction: image quality, diagnostic adequacy, and dose reduction. AJR Am J Roentgenol. 2012;198:1084–92.CrossRefGoogle Scholar
  51. 51.
    Park MJ, Lim JS. Computed tomography enterography for evaluation of inflammatory bowel disease. Clin Endosc. 2013;46:327–66.CrossRefGoogle Scholar
  52. 52.
    Stange EF, Travis SP, Vermeire S, Beglinger C, Kupcinskas L, Geboes K, et al. European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. Gut. 2006;55(Suppl 1):i1–i15.CrossRefGoogle Scholar
  53. 53.
    Swanson G, Behara R, Braun R, Keshavarzian A. Diagnostic medical radiation in inflammatory bowel disease: how to limit risk and maximize benefit. Inflamm Bowel Dis. 2013;19:2501–8.CrossRefGoogle Scholar
  54. 54.
    Raman SP, Fishman EK. Computed tomography angiography of the small bowel and mesentery. Radiol Clin N Am. 2016;54:87–100.CrossRefGoogle Scholar
  55. 55.
    Lo Re G, Tudisca C, Vernuccio F, Picone D, Cappello M, Agnello F, et al. MR imaging of perianal fistulas in Crohn’s disease: sensitivity and specificity of STIR sequences. Radiol Med. 2016;121:243–51. Erratum in: Radiol Med 2016;121:252.CrossRefGoogle Scholar
  56. 56.
    Bandyopadhyay D, Bandyopadhyay S, Ghosh P, De A, Bhattacharya A, Dhali GK, et al. Extraintestinal manifestations in inflammatory bowel disease: prevalence and predictors in Indian patients. Indian J Gastroenterol. 2015;34:387–94.CrossRefGoogle Scholar
  57. 57.
    Patel NS, Pola S, Muralimohan R, Zou GY, Santillan C, Patel D, et al. Outcomes of computed tomography and magnetic resonance enterography in clinical practice of inflammatory bowel disease. Dig Dis Sci. 2014;59:838–49.CrossRefGoogle Scholar
  58. 58.
    Deepak P, Fletcher JG, Fidler JL, Bruining DH. Computed tomography and magnetic resonance enterography in Crohn’s disease: assessment of radiologic criteria and endpoints for clinical practice and trials. Inflamm Bowel Dis. 2016;22:2280–8.CrossRefGoogle Scholar
  59. 59.
    Jesuratnam-Nielsen K, Løgager VB, Munkholm P, Thomsen HS. Diagnostic accuracy of three different MRI protocols in patients with inflammatory bowel disease. Acta Radiol Open. 2015;4:2058460115588099.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Li Y, Hauenstein K. New imaging techniques in the diagnosis of inflammatory bowel diseases. Viszeralmedizin. 2015;31:227–34.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Jiang X, Asbach P, Hamm B, Xu K, Banzer J. MR imaging of distal ileal and colorectal chronic inflammatory bowel disease--diagnostic accuracy of 1.5 T and 3 T MRI compared to colonoscopy. Int J Color Dis. 2014;29:1541–50.CrossRefGoogle Scholar
  62. 62.
    Moy MP, Sauk J, Gee MS. The role of MR enterography in assessing Crohn’s disease activity and treatment response. Gastroenterol Res Pract. 2016;2016:8168695.CrossRefGoogle Scholar
  63. 63.
    Dambha F, Tanner J, Carroll N. Diagnostic imaging in Crohn’s disease: what is the new gold standard? Best Pract Res Clin Gastroenterol. 2014;28:421–36.CrossRefGoogle Scholar
  64. 64.
    Lew RJ, Ginsberg GG. The role of endoscopic ultrasound in inflammatory bowel disease. Gastrointest Endosc Clin N Am. 2002;12:561–71.CrossRefGoogle Scholar
  65. 65.
    Siddiqui MR, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum. 2012;55:576–85.CrossRefGoogle Scholar
  66. 66.
    Stidham RW, Higgins PD. Imaging of intestinal fibrosis: current challenges and future methods. United European Gastroenterol J. 2016;4:515–22.CrossRefGoogle Scholar
  67. 67.
    Pellino G, Pallante P, Selvaggi F. Novel biomarkers of fibrosis in Crohn’s disease. World J Gastrointest Pathophysiol. 2016;7:266–75.CrossRefGoogle Scholar
  68. 68.
    Dubron C, Avni F, Boutry N, Turck D, Duhamel A, Amzallag-Bellenger E. Prospective evaluation of free-breathing diffusion-weighted imaging for the detection of inflammatory bowel disease with MR enterography in childhood population. Br J Radiol. 2016;89:20150840.CrossRefGoogle Scholar
  69. 69.
    Li XH, Sun CH, Mao R, Huang SY, Zhang ZW, Yang XF, et al. Diffusion-weighted MRI enables to accurately grade inflammatory activity in patients of ileocolonic Crohn’s disease: results from an observational study. Inflamm Bowel Dis. 2017;23:244–53.CrossRefGoogle Scholar
  70. 70.
    Anupindi SA, Podberesky DJ, Towbin AJ, Courtier J, Gee MS, Darge K, et al. Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging. 2015;40:975–92.CrossRefGoogle Scholar
  71. 71.
    Åkerman A, Månsson S, Fork FT, Leander P, Ekberg O, Taylor S, et al. Computational postprocessing quantification of small bowel motility using magnetic resonance images in clinical practice: an initial experience. J Magn Reson Imaging. 2016;44:277–87.CrossRefGoogle Scholar
  72. 72.
    Henkelman RM, Stanisz GJ, Graham SJ. Magnetization transfer in MRI: a review. NMR Biomed. 2001;14:57–64.CrossRefGoogle Scholar
  73. 73.
    Adler J, Swanson SD, Schmiedlin-Ren P, Higgins PD, Golembeski CP, Polydorides AD, et al. Magnetization transfer helps detect intestinal fibrosis in an animal model of Crohn disease. Radiology. 2011;259:127–35.CrossRefGoogle Scholar
  74. 74.
    Dillman JR, Swanson SD, Johnson LA, Moons DS, Adler J, Stidham RW, et al. Comparison of noncontrast MRI magnetization transfer and T2-weighted signal intensity ratios for detection of bowel wall fibrosis in a Crohn’s disease animal model. J Magn Reson Imaging. 2015;42:801–10.CrossRefGoogle Scholar
  75. 75.
    Holtmann MH, Uenzen M, Helisch A, Dahmen A, Mudter J, Goetz M, et al. 18F-Fluorodeoxyglucose positron-emission tomography (PET) can be used to assess inflammation non-invasively in Crohn’s disease. Dig Dis Sci. 2012;57:2658–68.CrossRefGoogle Scholar
  76. 76.
    Beiderwellen K, Kinner S, Gomez B, Lenga L, Bellendorf A, Heusch P, et al. Hybrid imaging of the bowel using PET/MR enterography: feasibility and first results. Eur J Radiol. 2016;85:414–21.CrossRefGoogle Scholar
  77. 77.
    Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;247:64–79.CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Gastroenterology 2018

Authors and Affiliations

  • Shalini Thapar Laroia
    • 1
  1. 1.Department of RadiologyInstitute of Liver and Biliary SciencesNew DelhiIndia

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