Table 2 Comparison of imaging modalities in the evaluation of Crohn’s disease
From: Small bowel MR enterography: problem solving in Crohn’s disease
Imaging Modality | Advantages | Disadvantages |
|---|---|---|
Barium follow-through | Good depiction of early bowel disease compared to CTE/MRE | Radiation burden; time consuming, operator and patient dependent leading to limited sensitivity; difficulty in assessing extramural complications |
Ultrasound | No radiation; may show terminal ileal disease well | Operator and patient dependent; comprehensive examination is not possible; time consuming |
CTE | Fast (< 5 mins); greater spatial resolution than MRE; multiplanar reformats are possible; mural and extramural complications are seen | Radiation burden; early disease is not well seen; cine imaging is not possible |
MRE | No radiation; high soft tissue contrast; multiplanar ability; shows mural and extramural complications; defines activity of disease; cine imaging is possible; can combine with perianal imaging | Longer scan time than CTE (20 mins); early disease is not well seen; suboptimal distention of proximal small bowel |
Enteroclysis (barium/CT/MRI) | Very good distension; can identify early ulceration, wall thickening, fistulae, sinus tracts | Radiation burden; invasive; time consuming |
Nuclear medicine techniquesa | Similar diagnostic accuracy to CTE and MRE | Radiation burden; time consuming; poor localisation (unless PET-CT) |
Balloon enteroscopy | Evaluate small bowel mucosa; biopsy is possible | Requires sedation/anesthesia; extramural complications not assessed; risk of pancreatitis, bleeding, small bowel perforation |
Capsule endoscopy | Evaluate small bowel mucosa | Cannot use in stricturing disease; battery exhaustion; poor localisation; extramural complications are not assessed |