Moderne Bildgebung bei CED

Zusammenfassung

Durch die ständige Weiterentwicklung der Computertomografie (CT) und der MRT, aber auch durch die Einführung neuer Verfahren wie die kontrastgestützte hochauflösende Sonografie, haben sich zusammen mit den Updates der S3-Leitlinien zur Diagnostik und Therapie bei chronisch entzündlichen Darmerkrankungen viele Änderungen bezüglich der Anwendung radiologischer Verfahren ergeben. In dem Übersichtsartikel soll basierend auf aktueller Literatur und Leitlinien ein kritischer Überblick der Verfahren bei Morbus Crohn und Colitis ulcerosa erfolgen. Ergänzt wird diese Übersicht durch Ausblicke neuer experimenteller bildgebender Verfahren, wie etwa der Diffusionsbildgebung in der MRT bei Darmerkrankungen.

Abstract

Because of the steady evolution of radiological imaging equipment, especially for CT and MR imaging, enriched by new ultrasound methods such as contrast enhanced high resolution ultrasound, several changes for radiological imaging in IBD came up. Additionally updated S3 guidelines recommend some new imaging approaches. In this review article a critical overview of radiological imaging in Crohn’s diseases as well as in ulcerative colitis is presented. Moreover recently introduced, more experimental imaging techniques such as diffusions weighted MR imaging is critically discussed.

Schlüsselwörter

MRT - CT - Sonografie - Bildgebung - chronisch entzündliche Darmerkrankungen

Key words

MRI - CT - ultrasound - imaging - IBD

• Literatur

• 1 Hoffmann JC, Autschbach F, Bokemeyer B et al. Short version of the updated German S3 (level 3) guideline on diagnosis and treatment of Crohn’s disease. Deutsche medizinische Wochenschrift (1946) 2008; 133: 1924-1929
• 2 Schreyer AG, Ludwig D, Koletzko S et al. Updated German S3-guideline regarding the diagnosis of Crohn’s disease  – implementation of radiological modalities. Rofo 2010; 182: 116-121
• 3 Mowat C, Cole A, Windsor A et al. Guidelines for the management of inflammatory bowel disease in adults. Gut 2011; 60: 571-607
• 4 Desmond AN, O’Regan K, Curran C et al. Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gu 2008; 57: 1524-1529
• 5 Ott DJ, Chen YM, Gelfand DW et al. Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy. Radiology 1985; 155: 31-34
• 6 Toms AP, Barltrop A, Freeman AH. A prospective randomised study comparing enteroclysis with small bowel follow-through examinations in 244 patients. European radiology 2001; 11: 1155-1160
• 7 Kelvin FM, Maglinte DD. Enteroclysis or small bowel follow-through in Crohn’s diseases?. Gastroenterology 1998; 114: 1349-1351
• 8 Sellink JL. Radiologic examination of the small intestine by duodenal intubation. Acta Radiol 1974; 15: 318-332
• 9 Schreyer AG, Menzel C, Friedrich C et al. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World Journal of Gastroenterology WJG 2011; 17: 1018-1025
• 10 Schreyer AG, Finkenzeller T, Gossmann H et al. Microcirculation and perfusion with contrast enhanced ultrasound (CEUS) in Crohn’s disease: first results with linear contrast harmonic imaging (CHI). Clin Hemorheol Microcirc 2008; 40: 143-155
• 11 Girlich C, Schacherer D, Lamby P et al. Innovations in contrast enhanced high resolution ultrasound improve sonographic imaging of the intestine. Clinical Hemorheology and Microcirculation 2010; 45: 207-215
• 12 Jung EM, Schreyer AG, Schacherer D et al. New real-time image fusion technique for characterization of tumor vascularisation and tumor perfusion of liver tumors with contrast-enhanced ultrasound, spiral CT or MRI: first results. Clin Hemorheol Microcirc 2009; 43: 57-69
• 13 Rubesin SE, Levine MS, Laufer I et al. Double-contrast barium enema examination technique. Radiology 2000; 215: 642-650
• 14 Schreyer AG, Seitz J, Feuerbach S et al. Modern imaging using computer tomography and magnetic resonance imaging for inflammatory bowel disease (IBD). Inflammatory Bowel Diseases 2004; 10: 45-54
• 15 Schreyer AG, Herfarth H, Kikinis R et al. 3D modeling and virtual endoscopy of the small bowel based on magnetic resonance imaging in patients with inflammatory bowel disease. Investigative Radiology 2002; 37: 528-533
• 16 Schreyer AG, Scheibl K, Heiss P et al. MR colonography in inflammatory bowel disease. Abdom Imaging 2006; 31: 302-307
• 17 Siddiki HA, Fidler JL, Fletcher JG et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR 2009; 193: 113-121
• 18 Horsthuis K, Bipat S, Bennink RJ et al. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008; 247: 64-79
• 19 Choi D, Jin LeeS, Ah ChoY et al. Bowel wall thickening in patients with Crohn’s disease: CT patterns and correlation with inflammatory activity. Clinical Radiology 2003; 58: 68-74
• 20 Booya F, Fletcher JG, Huprich JE et al. Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology 2006; 241: 787-795
• 21 Madureira AJ. The comb sign. Radiology 2004; 230: 783-784
• 22 Jaffe TA, Gaca AM, Delaney S et al. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn’s disease. AJR 2007; 189: 1015-1022
• 23 Wold PB, Fletcher JG, Johnson CD et al. Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy  – feasibility study. Radiology 2003; 229: 275-281
• 24 Schreyer AG, Geissler A, Albrich H et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol 2004; 2: 491-497
• 25 Low RN, Francis IR, Politoske D et al. Crohn’s disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging 2000; 11: 127-135
• 26 Schwartz DA, Loftus Jr EV, Tremaine WJ et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 2002; 122: 875-880
• 27 Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. The British Journal of Surgery 1976; 63: 1-12
• 28 Marks CG, Ritchie JK. Anal fistulas at St Mark’s Hospital. The British Journal of Surgery 1977; 64: 84-91
• 29 Schwartz DA, Wiersema MJ, Dudiak KM et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064-1072
• 30 Kiryu S, Dodanuki K, Takao H et al. Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. Journal of Magnetic Resonance Imaging JMRI 2009; 29: 880-886
• 31 Oussalah A, Laurent V, Bruot O et al. Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease. Gut 2010; 59: 1056-1065