Imaging for Inflammatory Bowel Disease. Surg Clin North Am. 2015;95:1143-1158, v. [PMID: 26596919 DOI: 10.1016/j.suc.2015.07.007]

Analysis of nanomedicine applications for inflammatory bowel disease: structural and temporal dynamics, research hotspots, and emerging trends

Background

The application of nanomedicine in inflammatory bowel disease (IBD) has gained significant attention in the recent years. As the field rapidly evolves, analyzing research trends and identifying research hotpots are essential for guiding future advancements, and a comprehensive bibliometric can provide valuable insights.

Methods

The current research focused on publications from 2001 to 2024, and was sourced from the Web of Science Core Collection (WoSCC). CiteSpace and VOSviewer were employed to visualize authors, institutions, countries, co-cited references, and keywords, thereby mapping the intellectual structure and identifying emerging trends in the field.

Results

The analysis covered 1,518 literature across 447 journals, authored by 9,334 researchers from 5,459 institutions and 287 countries/regions. The global publication numbers exhibited an upward trend, particularly in the last decade, with China leading as the top publishing country and the Chinese Academy of Sciences emerging as the foremost institution. Dr. Xiao Bo is the prominent figure in advanced drug delivery systems. This interdisciplinary field, which spans materials science, pharmacy, and medicine, has seen influential publications mainly concentrated on targeted nanoparticles treatment for IBD. Keyword analysis revealed that current research hotspots include drug delivery, immune cell regulation, antioxidant damage, intestinal microbiota homeostasis, and nanovesicles.

Conclusion

This study offers a comprehensive overview of global research landscape, emphasizing the rapid growth and increasing complexity of this field. It identifies key research hotspots and trends, including efforts to enhance the precision, efficacy, and safety of nanomedicine applications. Emerging directions are highlighted as crucial for further progress in this evolving area.

Computed Tomography and Magnetic Resonance Enterography: From Protocols to Diagnosis

Both Magnetic Resonance Enterography (MRE) and Computed Tomography Enterography (CTE) are crucial imaging modalities in the diagnosis and treatment of inflammatory bowel disease (IBD). CTE is often used in acute scenarios, such as when complications (such as abscesses, perforations, or bowel obstructions) are suspected. It can also help determine the degree and extent of pathological processes. Although CTE is rapid, generally accessible, and offers precise images that are useful in emergencies, it does expose patients to ionizing radiation. Nevertheless, MRE is very useful in assessing perianal illness and the small intestine, and it is frequently used in patients who need repeated follow-ups or are pregnant to minimize radiation exposure. Moreover, MRE can demonstrate oedema, fistulas, abscesses, and the thickening of the bowel wall. In addition, MRE offers superior soft tissue contrast resolution without ionizing radiation, which helps identify complications such as fistulas and abscesses. With their respective advantages and disadvantages, both approaches play essential roles in assessing IBD. The primary goal of this review is to provide an overview of the technical specifications, benefits, drawbacks, and imaging findings of CTE and MRE.

Computerized tomography features acting as predictors for invasive therapy in the management of Crohn's disease-related spontaneous intra-abdominal abscess: experience from long-term follow-up

BACKGROUND

Decision-making in the management of Crohn's disease (CD)-related spontaneous intra-abdominal abscess (IAA) is challenging. This study aims to reveal predictive factors for percutaneous drainage and/or surgery in the treatment of CD-related spontaneous IAA through long-term follow-up.

METHODS

Data were collected, including clinical manifestations, radiography and treatment strategies, in Chinese patients with CD-related IAA in a tertiary medical center. Univariate and Multivariate Cox analysis were conducted to identify predictors for invasive therapy.

RESULTS

Altogether, 48 CD patients were identified as having IAA through enhanced CT scans. The median follow-up time was 45.0 (23.3, 58.0) months. 23 (47.9%) patients underwent conservative medical treatment, and 25 (52.1%) patients underwent percutaneous drainage and/or surgical intervention (invasive treatment group). The 1-, 2-, and 5-year overall survival rates without invasive treatment were 75.0%, 56.1%, and 46.1%, respectively. On univariate Cox analysis, the computerized tomography (CT) features including nonperienteric abscess (HR: 4.22, 95% CI: 1.81-9.86, p = 0.001), max abscess diameter (HR: 1.01, 95% CI: 1.00-1.02, p<0.001) and width of sinus (HR: 1.27, 95% CI: 1.10-1.46, p = 0.001) were significantly associated with invasive treatment. Nonperienteric abscess was significantly associated with invasive treatment on multivariate Cox analysis (HR: 3.11, 95% CI: 1.25-7.71, p = 0.015). A score model was built by width of sinus, location of abscess and max abscess diameter to predict invasive treatment. The AUC of ROC, sensitivity and specificity were 0.892, 80.0% and 90.9% respectively.

CONCLUSIONS

More than half of CD-related IAA patients needed invasive therapy within 5-year follow-up. The CT features including nonperienteric abscess, larger maximum abscess diameter and width of sinus suggested a more aggressive approach to invasive treatment.

Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis

Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria^® which outlines imaging options based on location of pain.

Overview of the Large Bowel Assessment Using Magnetic Resonance Imaging: Different Techniques for Current and Emerging Clinical Applications

Radiological assessments of the small and large bowel are essential in daily clinical practice. Over plain film X-ray and ultrasound, cross-sectional techniques are considered the most comprehensive imaging modalities. In fact, computed tomography and magnetic resonance imaging take great advantage of the three-dimensional appraisal and the extensive evaluation of the abdominal cavity, allowing intestinal evaluation as well as detection of extra-intestinal findings. In this context, the chief advantage of computed tomography is the fast scan time, which is crucial for emergency cases. Nonetheless, it is undeniably impaired using ionizing radiation. As the awareness of radiation exposure is a topic of increasing importance, magnetic resonance imaging is not only becoming a mere alternative but also a primary imaging technique used in assessing intestinal diseases. Specifically, the evaluation of the large bowel through MRI can be still considered relatively uncharted territory. Although it has demonstrated superior accuracy in the assessment of some clinical entities from inflammatory bowel disease to rectal carcinoma, its role needs to be consolidated in many other conditions. Moreover, different technical methods can be applied for colonic evaluation depending on the specific disease and segment involved. This article aims to provide a thorough overview of the techniques that can be utilized in the evaluation of the large bowel and a discussion on the major findings in different colonic pathologies of primary interest.

The comb sign in a patient with Crohn's disease

There are many CT findings suggestive of Crohn's disease. The comb sign is one of them, and the sign helps us to diagnose it.

Abdominal X-rays in children: indications, procedure and interpretation

Abdominal X-rays (AXRs) are often used as an imaging modality in children who present with abdominal pain with a suspected serious underlying pathology. Nausea, vomiting and constipation that are unresponsive to treatment may also prompt a request for an AXR in a child. Nurses play an important role in ensuring that requests for AXRs in children are appropriate and that the procedure is performed safely. This is the second of two articles on the use of AXRs for diagnosing abdominal pathologies in childhood. The first article focused on AXRs in neonates. This one focuses on AXRs in children, discussing their indications, procedure and interpretation and describing abdominal conditions in children for which an AXR is likely to support diagnosis.

The accuracy of intestinal ultrasound compared with small bowel capsule endoscopy in assessment of suspected Crohn's disease in patients with negative ileocolonoscopy

BACKGROUND

Small bowel involvement in Crohn's disease (CD) is frequently proximal to the ileocecal valve and inaccessible by conventional ileocolonoscopy (IC). Small bowel capsule endoscopy (SBCE) is among the prime modalities for assessment of small bowel disease in these patients. Intestinal ultrasound (IUS) is an accurate bedside fast and low-cost diagnostic modality utilized in CD for both diagnosis and monitoring. The aim of this study was to examine the accuracy of IUS in patients with suspected CD after a negative IC, and to evaluate the correlation of IUS with SBCE, inflammatory biomarkers and other cross-sectional imaging techniques.

METHODS

Prospective single center study in which patients with suspected CD underwent IUS and SBCE examinations within 3 days. IUS results were blindly compared with SBCE that served as the gold standard. A post hoc comparison was performed of IUS and SBCE results and available cross-sectional imaging results (computed tomography or magnetic resonance enterography) as well as inflammatory biomarkers if measured. The study cohort was followed for 1 year. In case of discordance between the IUS and SBCE results, the diagnosis at 1 year was reported.

RESULTS

Fifty patients were included in the study. The diagnostic yield of both IUS and SBCE for the diagnosis of small bowel CD was 38%. The IUS findings significantly correlated to small bowel inflammation detected by SBCE (r = 0.532, p < 0.001), with fair sensitivity and specificity (72% and 84%). Cross-sectional imaging results significantly correlated to IUS as well (r = 0.46, p = 0.018). Follow up was available in 8 of the 10 cases of discordance between IUS and SBCE. In all of these cases, diagnosis of CD was not fully established at the end of the follow up.

CONCLUSIONS

The diagnostic yield of CE and IUS for detection of CD in patients with negative ileocolonoscopy was similar. IUS can be a useful diagnostic tool in suspected CD when IC is negative.

Diagnostic value of capsule endoscopy combined with computed tomography enterography for small intestinal diseases

AIM: To assess diagnostic value of capsule endoscopy (CE) combined with computed tomography enterography (CTE) for small bowel diseases.

METHODS: One hundred and fourteen patients with suspected small bowel diseases underwent CE and CTE examinations (interval time 2-7 d). The diagnostic accuracy for small bowel diseases was compared between CE and CTE, based on pathological or follow-up results. The diagnostic accuracy of combined CE and CTE was also estimated.

RESULTS: The symptoms of enrolled patients included obscure gastrointestinal bleeding (OGIB, 35 cases), unexplained abdominal pain (32 cases), suspected Crohn's disease (29 cases) and unexplained weight loss (18 cases). For OGIB, CE had a higher diagnostic accuracy than CTE (51.4% vs 40.0%, P < 0.05). The diagnostic accuracy reached 57.1% when the two methods were combined. For unexplained abdominal pain, diagnostic accuracy was comparable between CE and CTE (46.9% vs 40.6%, P > 0.05). The diagnostic accuracy reached 59.3% when the two methods were combined, which was higher than that of CE or CTE alone. For suspected Crohn's disease, CE had a higher diagnostic accuracy than CTE (86.2% vs 65.5%, P < 0.05). The diagnostic accuracy reached 93.1% when the two methods were combined, which was higher than that of CTE alone.

CONCLUSION: Both CE and CTE prove to be effective procedures for patients with suspected small bowel disease, but the diagnostic value of CE is higher than that of CTE for OGIB and suspected Crohn's disease. The combination of CE and CTE may be a better strategy.