Gastrointestinal Imaging Advances Improve Speed and Delivery of Diagnostic and Treatment Options

“GI has undergone a number of exciting and rapid technological advances during the past two decades. This has resulted in new areas of clinical application for the management of patients with GI and abdominal pathology, with improvements both in speed and diagnostic accuracy of the cross-sectional imaging modalities, as well as the emergence of new functional and quantitative techniques,” said Dr. Simon Jackson, consultant GI radiologist at Derriford Hospital (Plymouth, UK), who chaired the session.
Specifically, the role of nonionizing radiation modalities such as ultrasound and magnetic resonance imaging (MRI), and developments in dual-energy computed tomography (CT) have led to substantial improvements in the assessment of anatomy, organ function, and disease activity, he pointed out.

Contrast-enhanced ultrasound (CEUS), although currently widely used for the characterization of liver lesions, may play a critical role in the evaluation of bowel wall microvascularity, particularly in patients with Crohn’s disease (CD), according to Dr. Francesca Maccioni, a gastrointestinal radiologist working at the Umberto I Polyclinic Hospital (Rome, Italy). CEUS enables radiologists to assess the level, dynamics, and characteristics of contrast-enhancement in diseased intestinal segments without radiation exposure. The technique has good sensitivity and specificity for evaluating CD activity, assessing microvascular alterations before and after drug treatment, and may also be beneficial for tracking therapeutic effects, she explained.

However, the technology does have limits. “CEUS cannot provide information on the entire small and large bowel, because of its limited field of view. Only a few centimeters of diseased bowel, usually the terminal ileum, can be investigated, while CD frequently involves longer intestinal segments. Therefore, the choice of which segment to analyze with CEUS is crucial. A limited evaluation may impair the diagnostic accuracy of the examination. CEUS of the bowel should be considered an advanced but focused diagnostic tool, for use after a comprehensive intestinal evaluation,” said Dr. Maccioni, who gave the first presentation of the session.

Dual-energy CT is another interesting modality with potential for imaging the GI tract, and the second talk by Dr. Patrick Rogalla, head of the abdominal division at the University of Toronto (Canada), centered on its clinical applications, which include mesenteric ischemic disease, bleeding, CD, as well as CT colonography, polyp detection, and digital cleansing using computer-aided detection.

In the last presentation, Prof. Stuart Taylor, consultant GI radiologist at University College Hospital, London (UK) spoke about current developments in rapid sequence MRI. The technique allows the capture of intestinal motility and the assessment of bowel function, including gastric emptying and small bowel peristalsis. The presentation covered fundamental MRI protocols used for motility assessment and how software can be used to quantify activity, particularly in patients with Crohn’s disease.

Related Links:
Derriford Hospital
University College Hospital, London
University of Toronto