ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One) | March 2026-Radiology Studies Case 3-IBD Imaging in Work Up and Management

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This document is a radiology-focused review of non-invasive imaging for inflammatory bowel disease (IBD), particularly Crohn’s disease (CD), with emphasis on intestinal ultrasound (IUS), magnetic resonance enterography (MRE), and computed tomography enterography (CTE). The objectives are to compare these modalities and illustrate their use through cases.<br /><br />IUS is highlighted as a real-time, radiation-free tool that assesses bowel wall thickness and vascularity and correlates well with endoscopic outcomes in CD. Key IUS inflammatory measures include bowel wall thickness, hyperemia (Doppler flow), stratification, inflammatory fat changes, lymphadenopathy, and detection of complications. IUS may also help patient-clinician shared understanding and can predict disease course: in a Copenhagen cohort, higher IBUS-SAS scores at diagnosis were associated with greater short-term risk of IBD-related surgery. In the METRIC trial, IUS showed high sensitivity (92%) for small-bowel CD, close to MRE (97%), and requires minimal preparation.<br /><br />MRE provides high soft-tissue contrast and evaluates intramural and extra-intestinal disease, strictures, and penetrating complications; it is considered first-line for perianal/pelvic pathology and is preferred in children/younger patients. CTE is widely used and often first-line, offering strong assessment of intramural and extra-intestinal findings, treatment response, and differentiation of active vs fibrotic disease, but repeat use is limited by radiation and contrast risks.<br /><br />Case examples focus on stricturing and penetrating CD: (1) a young patient with obstructive symptoms and ileocecal stricture despite biologic therapy; (2) a man with stricturing CD and partial small bowel obstruction despite infliximab and normal biomarkers, emphasizing imaging’s role when labs are misleading; and (3) persistent perianal disease requiring MRI pelvis. Key takeaway: management of stricturing CD depends on symptoms plus radiology and endoscopy, and fibrostenotic-predominant strictures may require dilation or surgery.

Asset Subtitle

Amy Stewart, CRNP

Keywords

inflammatory bowel disease imaging

Crohn’s disease

intestinal ultrasound (IUS)

magnetic resonance enterography (MRE)

computed tomography enterography (CTE)

bowel wall thickness

Doppler hyperemia

stricturing Crohn’s disease

penetrating complications

perianal MRI pelvis