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. 2012:2012:816920.
doi: 10.1155/2012/816920. Epub 2012 Jan 18.

Crohn's disease imaging: a review

Gianluca Gatta  1 , Graziella Di Grezia, Veronica Di Mizio, Cinzia Landolfi, Luigi Mansi, Ilario De Sio, Antonio Rotondo, Roberto Grassi
Affiliations

Crohn's disease imaging: a review

Gianluca Gatta et al. Gastroenterol Res Pract. 2012.

Abstract

Crohn's disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract, which can involve almost any segment from the mouth to the anus. Typically, Crohn's lesions attain segmental and asynchronous distribution with varying levels of seriousness, although the sites most frequently involved are the terminal ileum and the proximal colon. A single gold standard for the diagnosis of CD is not available and the diagnosis of CD is confirmed by clinical evaluation and a combination of endoscopic, histological, radiological, and/or biochemical investigations. In recent years, many studies have been performed to investigate the diagnostic potential of less invasive and more patient-friendly imaging modalities in the evaluation of Crohn's disease including conventional enteroclysis, ultrasonography, color-power Doppler, contrast-enhanced ultrasonography, multidetector CT enteroclysis, MRI enteroclysis, and 99mTc-HMPAO-labeled leukocyte scintigraphy. The potential diagnostic role of each imaging modality has to be considered in different clinical degrees of the disease, because there is no single imaging technique that allows a correct diagnosis and may be performed with similar results in every institution. The aim of this paper is to point out the advantages and limitations of the various imaging techniques in patients with suspected or proven Crohn's disease.

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Figures

Figure 1
Figure 1
Conventional enteroclysis. (a) Conventional enteroclysis: panoramic view. (b) Mild wall thickening in the ileum. (c) Scattered linear aphthoid lesions (arrow) in a segment of distal small bowel. (d) Mucosal ulcers (arrows). (e) Typical cobblestone-like nodular filling defects and ulceration. (f) Fistula (arrows). (g) Stenotic loop (arrows).
Figure 2
Figure 2
US. (a) Wall thickening without stratification and hyperecoic lumen. Regular outer margin of the loop. Mesenteric fat hypertrophy. (b) Coexistence of two patterns. Stenotic and thickened loop with preserved stratification and an adjcent segment with loss of stratification. (c) Stenotic intestinal tract characterized by marked dilatation of the bowel lumen, with thickened bowel wall. (d) Wall thickening with loss of normal stratification. Discontinuous outer margin with hypoecoic indented irregularities due to extramural findings.
Figure 3
Figure 3
PDs. Wall thickening in B mode (a), in PD (b), (c), (d), and arterial doppler spectrum (e).
Figure 4
Figure 4
CEUS. Last ileal loop wall thickening and submucosal contrast enhancement after contrast medium (SonoVue, Bracco). 0 (a), 15 (b), 30 (c), and 45 (d) sec.
Figure 5
Figure 5
MDCT-E. Intraintestinal findings: intramural (a), (b) wall thickening (b) (“double halo sign”), (c) hyperemia of the mucosa, (d) ulcer, (e) stenosis, extramural (f) engorgement of vasa recta (“comb sign”). Extraintestinal findings: (g), (h) lymph nodes involvement and mesenteric fat stranding, (i) abscess.
Figure 6
Figure 6
MR-E. (a), (b) Coronal true fast induction steady-state potential and single-shot hydrographic sequence showing a suitable degree of jejunum distension.
Figure 7
Figure 7
MR-E. Last ileal loop wall thickening (a), (b) axial TRUFI T2. (c), (d) Coronal TRUFI T2. (e) Coronal FLASH 3D. (f), (g), (h) Coronal FLASH 3D postcontrast medium.
Figure 8
Figure 8
MR-E. Crohn's disease: colon involvement (a), (b) coronal TRUFI T2 showing (c) axial TRUFI T2; (d) coronal TRUFI T2.
Figure 9
Figure 9
MR-E. (a) Coronal TRUFI T2 showing ileal loop wall thickening. (b) Intensity/time curve not showing inflammatory activity.
Figure 10
Figure 10
TLLS. (a) No inflammatory activity; (b) mild inflammatory activity; (c) moderate inflammatory activity; (d) severe inflammatory activity.
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