Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines

Abstract

The management of patients with IBD requires evaluation with objective tools, both at the time of diagnosis and throughout the course of the disease, to determine the location, extension, activity and severity of inflammatory lesions, as well as, the potential existence of complications. Whereas endoscopy is a well-established and uniformly performed diagnostic examination, the implementation of radiologic techniques for assessment of IBD is still heterogeneous; variations in technical aspects and the degrees of experience and preferences exist across countries in Europe. ECCO and ESGAR scientific societies jointly elaborated a consensus to establish standards for imaging in IBD using magnetic resonance imaging, computed tomography, ultrasonography, and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations for different clinical situations that include general principles, upper GI tract, colon and rectum, perineum, liver and biliary tract, emergency situation, and the postoperative setting. The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas such as the comparison of diagnostic accuracy between different techniques, the value for therapeutic monitoring, and the prognostic implications of particular findings.

The development of a magnetic resonance imaging index for fistulising Crohn's disease

“…1 The original van Assche index consists of six anatomical and (weighted) inflammatory disease parameters including assessment of; the numbers of fistula tracts (0 -3), the location of fistulas (1 -3), extension of fistulas (1 or 2), hyperintensity on T2-weighted images (0, 4, or 8), presence of collections (defined as cavities >3 mm in diameter) (0 or 4) and rectal wall involvement (score 0 or 2). The total score ranges from 0 to 22; 2 Definitions were applied to modified index only; 3 Adapted from the St. Mark's Classification 23 in the modified index (the most dominant feature is assessed for both the original and modified indices); 4 For the modified index, all relevant findings are identified; the highest score is chosen; 5 For the modified index, extensions were also assessed and the most severe lesion was rated by comparing signal intensity with nearby, in-plane vessels in the modified index; images were fat saturated Table 2. Reliability* of the VAS, original and modified van Assche indices.…”

“…Table 1 for original item and definition). 1 Primary tract and/or extensions; 2 Mark all that apply and measure fluid collection only (excluding wall) on the shortest axis 3 Infiltrate describes an inflammatory region as a whole that may or may not include one or more fluid collections. To provide superior differentiation between supra-and infralevatoric extensions, this junction is now defined as the connection of the levator plane to the ano-rectum and is delineated by two arrows in this coronal oblique T2-weighted image.…”

“…In clinical practice, pelvic magnetic resonance imaging (MRI) has an established role for the evaluation of patients with perianal fistulas and is used to make clinical decisions and assess changes in disease state. 3,4 While several scoring systems, such as the Fistula Drainage Assessment and the partially validated Perianal Disease Activity Index, have been used to quantify clinical parameters, far fewer have been developed for MRI and they also lack standardised definitions of descriptor items. 5 The most frequently used MRI index is the Van Assche index, originally developed to fulfill the need for an instrument that could measure response of perianal fistulising CD to medical therapy.…”

SICUS and CEUS imaging in Crohn’s disease: an update

“…The European Crohn's and Colitis Organisation (ECCO) and American College of Gastroenterology guidelines considered CT or MRI as radiological imaging techniques with the highest diagnostic accuracy for the detection of intestinal involvement of CD, including extramural complications [3,8]. In a recent consensus conducted by the ECCO and European Society Gastrointestinal and Abdominal Radiology (ESGAR), no significant differences in diagnostic accuracy among the imaging techniques (US, CT, MRI) were observed [9]. However, CT and MRI also have disadvantages in the assessment of the disease.…”

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

“…Ultrasonography (US) is useful for diagnosis and staging of Crohn's disease affecting the terminal ileum, equivalent to CT enterography and MRI enterography according to the ECCO guidelines [1]. Changes in the terminal ileum wall are diagnosed using grayscale US, and lumen caliber can be assessed after administration of oral contrast agent.…”