Diagnostic Imaging and Scanning

Finding out if a person’s symptoms are linked to an inflammatory bowel disease like Crohn’s disease (CD) or ulcerative colitis (UC) is a multi-step process.1,2 It includes physical examination, blood and stool testing, and diagnostic endoscopy procedures, which are often supported by information collected from diagnostic imaging and scans.

Diagnostic imaging and scanning are types of medical testing that use technology to capture an image or other kind of representation of the inside of a person’s body. These can be use to help confirm a diagnosis of inflammatory bowel disease (IBD), as well as showing the location and severity of inflammation and other types of complications that the disease can cause, such as strictures, fistulas, and abscesses.

What types of imaging and scans are used to diagnose inflammatory bowel disease?

The most common types of imaging and scanning that may be recommended for diagnosing patients with IBD include:1-3

  • X-rays
  • Contrast radiography
  • Computed tomography (CT) Scan
  • Magnetic Resonance Imaging (MRI)

How can X-rays help to detect signs of CD?

X-rays take a picture of the inside of a person’s body by passing a special kind of radiation energy through the body quickly and painlessly. X-rays can be used to detect blockages or perforations in the small and large intestines that may be caused by inflammation and scarring due to CD. In rare cases, people with UC may develop a widening of the large intestine called a toxic megacolon, which can be visible on x-rays.1

What is contrast radiography?

Contrast radiography is a type of diagnostic imaging in which a chalky liquid called barium is ingested into the large or small intestine, and a series of X-rays are taken over a period of time.1,3,4 The barium allows the healthcare provider to examine a clearer image of the soft tissues in the digestive tract than a normal X-ray will allow.

During a small bowel series (SBS), the patient swallows the barium by mouth, and X-rays are taken of the stomach, esophagus, and small intestines over a period of several hours. To examine the large intestine, a barium enema is used. This involves injecting barium into the colon through the rectum. In some cases, air is also pumped into the colon to provide an even better quality X-ray image.4,5

What is a CT scan?

A CT scan can provide the healthcare provider with cross-sectional images of the patient’s abdomen.1,6 CT imaging can provide very detailed images of the inside of the body that reveal more information than a regular X-ray image can. This is because a CT scan involves taking a large number of smaller images, while an X-ray usually involves taking only a few larger images. For patients with symptoms of CD, a CT scan can reveal the presence of inflammation, strictures, obstructions, fistulas, and abscesses.6

A special type of CT scanning is called CT enterography (CTE). This involves ingesting a contrast solution that allows a 3-D representation of the small intestine to be constructed. This allows an even more detailed examination that can reveal inflamed areas.7

What is an MRI scan?

Magnetic resonance imaging (MRI) is a procedure in which technology involving special magnets creates detailed pictures of the inside of the body. Unlike a CT scan, an MRI does not use radiation or x-ray technology. MRI scans can be particularly useful in detecting signs of perianal CD, as well as symptoms of CD that occur outside of the digestive tract.1,8

Written by: Anna Nicholson and Emily Downward | Last Reviewed: January 2018.
View References
  1. Diagnosing and managing IBD, Crohn’s and Colitis Foundation of America. Available at http://www.crohnscolitisfoundation.org/resources/diagnosing-and-managing-ibd.html. Accessed 1/2/18.
  2. Inflammatory bowel disease, Medscape. Available at https://emedicine.medscape.com/article/179037. Accessed 1/2/18.
  3. Wilkins T, Jarvis K, Patel J. Diagnosis and management of Crohn's disease. Am Fam Physician. 2011;84:1365-1375.
  4. Tests and Procedures: Barium enema, Mayo Clinic. Available at: http://www.mayoclinic.org/tests-procedures/barium-enema/basics/definition/prc-20019174. Accessed 1/2/18.
  5. Upper GI and small bowel series, MedlinePlus, U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/article/003816.htm. Accessed 1/2/18.
  6. Abdominal CT Scan, MedlinePlus, U.S. National Library of Medicine. Available at https://www.nlm.nih.gov/medlineplus/ency/article/003789.htm. Accessed 1/2/18.
  7. CT Enterography, Johns Hopkins Medicine. Available at https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60. Accessed 1/2/18.
  8. MRI, MedlinePlus, U.S. National Library of Medicine. Available at https://www.nlm.nih.gov/medlineplus/ency/article/003335.htm. Accessed 1/2/18.