Advanced imaging techniques in inflammatory bowel disease

When a patient presents with chronic and recurrent abdominal pain, it can be tough to nail down the cause. In this video, we’ll look at how to use inflammatory markers to differentiate between inflammatory and non-inflammatory causes of IBD, why it’s crucial that you figure out the difference, and what to do when the diagnosis is unclear.

Clinicians encounter inflammation daily and there are lots of inflammatory markers to consider. Which should you order for your patient? Here, you’ll learn the strengths and limitations of each marker, when they’re useful, and when they’re not. We’ll look at laboratory markers of inflammation as well as radiologic and clinical signs so you can take your diagnostic skills to the next level. Inflammation got you all flustered? With this course, you'll master the use of inflammatory markers to get to the right diagnosis.

Like serologic biomarkers, the use of advanced radiology has become an important tool in both diagnosing and managing inflammatory bowel diseases. The most commonly used are CT and MRI. Both modalities can be used to diagnose colitis. Though CT is often the more accessible of the two. It is beyond the scope of this Medmastery lesson to outline every single radiologic inflammatory biomarker. However, it is important to understand that signs of colitis are nonspecific and do not point to any particular ideology in general.

This is important to note because flares of IBD like Crohn's disease and ulcerative colitis, are known to have significant correlation with C. difficile colitis. In other words, you could have both ideologies of colitis seen on imaging. In these instances, follow up either with subsequent imaging or assessment of diagnosis and monitoring using serologic inflammatory biomarkers becomes vital. Imaging becomes especially useful in managing disease in patients with known IBD.

If we can identify complications early, we have a much better chance of altering prognosis and preventing future complications. Complications can be thought of in two categories. First is luminal complications, the second is extra luminal complications. Luminal complications that can be seen on imaging include strictures, dilations, and cancers. Extra luminal complications include adhesions, fistulas, abscesses, and perforations. IBD patients are at risk for immediately life threatening complications like bowel perforation.

A plane X ray of the kidneys, abdomen and bladder, historically referred to as KV's can show some bowel delimitation like toxic megacolon and perforations. This is where advanced radiology excels though, because of its accessibility CT abdomen has been the workhorse for this evaluation. But ultrasound has many advantages that have led to its growth in use as well. First of all, point of care ultrasound machines are becoming widely available in emergency departments and primary care offices.

This allows for immediate evaluation without transporting the patient to another location. Second, the ultrasounds ability to demonstrate colitis and perforations is improving considerably as the technology is improving. This has led to the incorporation of focused assessment with monography and trauma or fast scanning in the ED, this concept is being widely applied to non trauma presentations of abdominal pain now as well.