Imaging techniques in inflammatory bowel disease: recent trends, questions and answers

Imaging techniques have undergone substantial progress in recent years and contribute significantly in the diagnosis of inflammatory bowel diseases in conjunction with patient history, clinical and laboratory examination. Modern cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging allow an evaluation not only of the complete bowel wall of the small intestine, but also of extraluminal structures. They constitute a major diagnostic component in the initial workup, in stricturing or fistulizing disease and in suspected abscess. Transabdominal ultrasonography has been re-appreciated in these settings as an easy- and ready-to-use tool yielding real-time information. Positron emission tomography was found useful to add functional diagnosis of inflammation. Colonoscopy techniques still represent the gold standard for evaluation of inflammatory activity and for cancer surveillance. Here, chromoendoscopy has proven efficacy for enhanced detection of flat intraepithelial neoplasias in ulcerative colitis and has been incorporated into recent surveillance guidelines. Narrow band imaging may provide virtual chromoendoscopy in the future, but confirmatory studies are still on the way. Confocal endomicroscopy allows in vivo microscopy at high resolution and with excellent accuracy in first trials to predict histology of inflammatory and neoplastic lesions. The current data from endoscopic studies should result in an integrated approach to both identify and characterize a suspicious lesion during ongoing endoscopy for reliable, accurate diagnosis and targeted, immediate therapy.