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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Feb 28, 2016; 8(2): 124-131
Published online Feb 28, 2016. doi: 10.4329/wjr.v8.i2.124
Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?
Kelly Haas, Erika Rubesova, Dorsey Bass
Kelly Haas, Dorsey Bass, Department of Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA 94304, United States
Erika Rubesova, Department of Radiology, Lucile Packard Children’s Hospital Stanford, Palo Alto, CA 94304, United States
Author contributions: Haas K performed the literature review and wrote the manuscript with oversight, mentorship, and contribution to the manuscript by Rubesova E and Bass D.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Kelly Haas, Department of Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children’s Hospital Stanford, 750 Welch Road, Suite 116, Palo Alto, CA 94304, United States. kbhaas@stanford.edu
Telephone: +1-650-7235070 Fax: +1-650-4985608
Received: April 29, 2015
Peer-review started: May 8, 2015
First decision: September 8, 2015
Revised: November 24, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: February 28, 2016
Abstract

Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient’s lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient’s lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD.

Keywords: Inflammatory bowel disease, Ultrasound, Fluoroscopy, Magnetic resonance imaging, Computed tomography

Core tip: Imaging plays a key role in the diagnosis and lifelong evaluation of a patient with inflammatory bowel disease (IBD). Several imaging modalities are available, each with a unique set of risks and benefits when considering cost, anesthesia risk in the pediatric population, ionizing radiation, image quality, and availability. In this article, we review the imaging techniques available for evaluation of IBD, with particular focus on judicious use of ionizing radiation. We also review current imaging guidelines among pediatric and adult patients with IBD.