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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
  1. CTE CT enterography, MRE MR enterography
  2. aWhite cell scintigraphy, positron emission tomography