The clinical impact of cross-sectional imaging on crohn's disease management

A new era of Crohn's disease management exists where decisions are made by objective data as a necessary adjunct to patient symptoms. Cross-sectional imaging, particularly CT enterography (CTE) and MR enterography (MRE), provides powerful objective insights into the disease process resulting in a firm place for cross-sectional imaging in our current diagnostic and management paradigms. The high sensitivity and specificity of the techniques for the presence of bowel inflammation have helped pinpoint the location and severity of disease enabling diagnosis and facilitating assessment of symptoms. The ability to identify disease complications has helped direct medical therapy and enables more robust presurgical assessment. Emerging data suggest that cross-sectional imaging findings are sensitive to changes in inflammation resulting from our potent biologic therapies and may be used in amazing new ways such as in predicting disease course. Technological advances in CT and MR enterography have provided new insights into the disease processes while enhancing patient safety and tolerability. The goal of this chapter is to provide a gastroenterologist's view of how cross-sectional imaging fits our current and future management algorithm. These remarkable technologies enable gastroenterologists and radiologists, working together, to serve our patient population in profound ways.