2012 Advances in IBD: Perspectives on Imaging

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By Vijay Yajnik, MD, PhD

HOLLYWOOD, Fla.—Clinical and basic science research were presented at this year’s Crohn’s & Colitis Foundation of America (CCFA) Advances in IBD meeting—important advancements that may affect the lives of our patients with IBD. Of note, there was discussion amongst peers regarding the role of enterography, computed tomography enterography (CTE) and magnetic resonance enterography (MRE), and its overall impact on our patients’ diagnoses and management of small bowel disease such as Crohn’s disease.

In the GI community, we can all agree that a challenge with Crohn’s disease is that there is not one simple method in reaching a diagnosis quickly. Patients seeking answers to painful GI distress often seem to go in circles before they are properly diagnosed. The way in which we communicate to patients and explain how disease appropriate testing is essential to their care is paramount.

Whether it is CTE or MRE, imaging as a subject matter does not garner as much attention as other topics; however, it’s important to share the message with patients that proper imaging may speed the road to diagnosis and offers both patients and physicians a significant advantage due to the increased information it provides without the invasiveness.

When describing the importance of enterography with patients, ensure that they understand the full picture. Ask them to imagine this―the small intestine looks like spaghetti―it’s hard to identify one noodle from another. Enterography provides another exam which can help us understand the inner lining of the intestine, especially when paired with other tests (i.e. colonoscopy, endoscopy).

If your patient expresses concerns about the radiation associated with CTE, inform them that many new technology scanners have reduced the radiation dose and because of this we can work to minimize patients’ exposure to radiation, and with MRE, there is no radiation exposure.

During a symposium titled “The Future is Now: Personalizing Therapy: Therapeutic Monitoring, a Practical Approach" it was noted by Dr. Bruce Sands, a professor of medicine (gastroenterology), at Mount Sinai Hospital, that CTE or MRE may be used. However, MRE is increasingly becoming the modality of choice for the evaluation of suspected IBD, and management of disease progression and may be conducted prior to or after a colonoscopy is performed, Sands said.

Additionally, an informal poll of the room, of more than 500 IBD specialists, confirmed that CTE remains a complimentary tool in providing a more conclusive and accurate reporting of a patient’s prognosis.

Vijay Yajnik, MD, PhD, works at Massachusetts General Hospital.

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