Diagnostic imaging of inflammatory bowel disease

This article considers the possibilities of different image acquisition techniques in the study of inflammatory bowel disease, with special emphasis on the roles of tomodensitometry and magnetic resonance imaging. Although these techniques are not superior to barium follow through studies or conventional enteroclysis at depicting the mucosa in detail, they are very useful in the evaluation of the characteristics of the walls of the bowel loops and in the detection of possible extraluminal complications, such as abscesses, adenopathies, and mesenteric involvement. Magnetic resonance shows great potential for the study of the small bowel and is likely to play an important role in the study of inflammatory bowel disease in the near future. This recurring disease affects young patients with long life expectancies in whom exposure to ionizing radiation needs to be minimized. We explain the radiologic findings through a physiopathologic approach to the sequence of events (aphthoid ulcers, fissuring and penetrating ulcerations, formation of fistulous tracts, abscesses, mesenteric involvement) that give rise to them. We propose an objective classification based on the imaging findings that is useful for therapeutic decision making, and we describe the important role of the radiologist in the follow-up as well as in the diagnosis of this entity.