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ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease
Open accessAbstract
Background and Aims: The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. Methods: An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. Results: Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. Conclusions: This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
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“Further studies are warranted, but AI models for automatically detecting inflammatory-related changes could greatly aid in standardising image interpretation and scoring in clinical practice and trials, ultimately improving patient management.47-49”
From Artificial intelligence and endo-histo-omics: new dimensions of precision endoscopy and histology in inflammatory bowel disease (2024) · cites this paper as [47]
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Self-citationAutomatized detection of Crohn's disease in intestinal ultrasound using convolutional neural network
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Self-citationMucosal and Transmural Healing and Long-term Outcomes in Crohn’s Disease
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Self-citationImaging in inflammatory bowel disease: current and future perspectives
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“32 It is advocated to use a structured report and consistent terminology to more clearly convey findings and increase the reporting of relevant positive and negative findings to guide management.”
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Self-citationSmall bowel imaging in inflammatory bowel disease: updates for 2023
Hameed, M., & Taylor, S. A. (2023) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2023.2274926 · Cited by 31
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Self-citationHow I Do It: Cross-sectional Imaging in Small-Bowel Crohn Disease and Ulcerative Colitis
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“For diagnosing CD with MREC, the following findings were evaluated: mucosal ulcerations, bowel wall thickening (≥3 mm), bowel wall hyper‐enhancement, diffusion restriction, bowel stenosis, creeping fat, dilated vasa recta, and the presence of an abscess or fistula in conjunction to a diseased bowel segment.(16) The di…”
MethodSelf-citationAllocca, M., Buono, A. D., D’Alessio, S., Spaggiari, P., Garlatti, V., Spinelli, A., Faita, F., & Danese, S. (2023) · Journal of Ultrasound in Medicine · doi:10.1002/jum.16191 · Cited by 23
“• Stricture, defined as the presence of wall thickening (>3 mm) with a narrowed lumen with or without dilatation of a proximal loop.(13,16,18) • Upstream dilatation, as a dichotomous variable: 0, if absent; 1, if present.”
BackgroundResultSelf-citationUse of imaging modalities for decision-making in inflammatory bowel disease
Nancey, S., Fuméry, M., Faure, M., Boschetti, G., Gay, C., Milot, L. M., & Roblin, X. (2023) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848231151293 · Cited by 23
Buono, A. D., Faita, F., Armuzzi, A., Jairath, V., Peyrin‐Biroulet, L., Danese, S., & Allocca, M. (2025) · Journal of Crohn s and Colitis · doi:10.1093/ecco-jcc/jjaf023 · Cited by 25
Prognostic role of intestinal ultrasound in Crohn’s disease
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Self-citationImaging of Gastrointestinal Tract Ailments
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Self-citationThe Use of Endoscopic Ultrasonography in Inflammatory Bowel Disease: A Review of the Literature
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“Cross-sectional imaging techniques recommended by the European Crohn’s and Colitis Organization (ECCO) for the evaluation of patients with IBD include intestinal ultrasound (IUS), magnetic resonance imaging (MRI), computed tomography (CT), endoanal Diagnostics 2023, 13, 568. https://doi.org/10.3390/diagnostics13030568…”
InfluentialRecent advances in the use of ultrasound in Crohn’s disease
Barchi, A., D’Amico, F., Zilli, A., Furfaro, F., Parigi, T. L., Fiorino, G., Peyrin‐Biroulet, L., Danese, S., Buono, A. D., & Allocca, M. (2023) · Expert Review of Medical Devices · doi:10.1080/17434440.2023.2283166 · Cited by 15
“Finally, an ECCO-ESGAR consensus has recommended this threshold of 3 mm for presence of mural inflammation for both small and large bowel [26].”
BackgroundMethodSudoł‐Szopińska, I., Garg, P. K., Mellgren, A. F., Spinelli, A., Breukink, S. O., Iacobellis, F., Kołodziejczak, M., Ciesielski, P., Jenssen, C., SMART Collaborative Group, et al. (2024) · World Journal of Gastrointestinal Surgery · doi:10.4240/wjgs.v16.i10.3288 · Cited by 15
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“Recently, the European Crohn Colitis Organization (ECCO) released a topical review concerning the main elements to be assessed in evaluating bowel inflammation [9].”
BackgroundIntegrating Intestinal Ultrasound into an Inflammatory Bowel Disease Practice: How to Get Started
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Self-citationFernandez-Clotet, A., Ordás, Í., Masamunt, M. C., Caballol, B., Rodríguez, S., Gallego, M., Barastegui, R., Saavedra, A. C., Panés, J., Ricart, E., et al. (2024) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17968 · Cited by 13
Self-citationConsiderations on Multimorbidity and Frailty in Inflammatory Bowel Diseases
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“48,49 A relatively common clinical scenario which is important to mention is the older person found to have colonic inflammation following a radiological test done for another reason.”
BackgroundLo, R. W., Bhatnagar, G., Kutaiba, N., & Srinivasan, A. R. (2025) · World Journal of Gastroenterology · doi:10.3748/wjg.v31.i26.107419 · Cited by 11
“Finally, the routine application of MRE disease activity scores in the evaluation of radiological Crohn’s disease requires buy-in from both reporting radiologists and IBD clinicians[15].”
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Self-citationCicerone, C., D’Amico, F., Allocca, M., Zilli, A., Parigi, T. L., Danese, S., & Furfaro, F. (2024) · Diagnostics · doi:10.3390/diagnostics14141530 · Cited by 10
“…enterography (MRE), and intestinal ultrasound (IUS), provide complementary information useful in the diagnosis of IBD by contributing to the assessment of the extent of small bowel involvement in Crohn’s disease, evaluating the presence of complications, and assessing disease activity [88,89].”
BackgroundGastrointestinal Ultrasound: Measurements and Normal Findings – What Do You Need to Know?
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Imaging in perianal fistulising Crohn’s disease: A practical guide for the gastroenterologist
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“…utility is recognised in joint consensus statements from the European Crohn’s and Colitis Organisation (ECCO) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), which endorse both modalities as effective adjuncts to MRI in centres with appropriate expertise[7,24].”
Lu, C., Verstockt, B., Winter, M. W., Christensen, B., Carter, D., de Voogd, F. A. E., Dolinger, M. T., Goodsall, T. M., O’Brien, M. M., Rosentreter, R. E., et al. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70449 · Cited by 9
Self-citationMonitoring of patients with active inflammatory bowel disease
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Self-citationPredicting Treatment Response in Inflammatory Bowel Diseases: Cross-Sectional Imaging Markers
Mignini, I., Maresca, R., Ainora, M. E., Larosa, L., Scaldaferri, F., Gasbarrini, A., & Zocco, M. A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12185933 · Cited by 9
“A threshold of BWT ≥ 3 mm has been established in both CD and UC to distinguish between active and quiescent disease [18].”
BackgroundComprehensive review and update of stricturing Crohn’s disease
Elford, A. T., Ardalan, Z. S., Simkin, P. M., & Christensen, B. (2024) · Indian Journal of Gastroenterology · doi:10.1007/s12664-023-01508-8 · Cited by 9
“…European Crohn’s and Colitis Organisation (ECCO)- European Society of Gastrointestinal and Abdominal Radiology (ESGAR) guidelines propose luminal narrowing with upstream dilatation (≥ 3 cm) as a definite stricture and fixed luminal narrowing without upstream dilatation as a probable stricture [20].”
Miyoshi, J., Morikubo, H., Yonezawa, H., Mori, H., & Hisamatsu, T. (2023) · Intestinal Research · doi:10.5217/ir.2023.00003 · Cited by 9
“Previous clinical studies have proved the usefulness of CT and magnetic resonance imaging in assessing IBD activity.(5,6) However, these techniques have several limitations: (1) waiting time for the examination (not real-time examination); (2) fasting or drinking bowel preparation solution before an examination; (3) c…”
BackgroundHameed, M., Kock, I. D., Stoker, J., & Taylor, S. A. (2025) · European Radiology · doi:10.1007/s00330-025-11620-2 · Cited by 8
Self-citationKumar, S., Plumb, A., Mallett, S., Bhatnagar, G., Bloom, S. L., Clarke, C. S., Hamlin, P. J., Hart, A. L., Jacobs, I., Travis, S. P. L., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-067265 · Cited by 8
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Cross-Sectional Imaging of Pelvic Inflammatory Disease: Diagnostic Pearls and Pitfalls on CT and MR
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Self-citationMassironi, S., Zilli, A., Furfaro, F., Allocca, M., Peyrin‐Biroulet, L., Jairath, V., & Danese, S. (2025) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.70385 · Cited by 6
“In contrast, intestinal ultrasound (IUS) has emerged as a non-invasive, radiation-free, point- of-care imaging modality offering excellent diagnostic accuracy in IBD [22–30], supporting both disease diagnosis and longitudinal monitoring [30–33].”
Brodersen, J. B., Jensen, M. D., Juel, M. A., Kjeldsen, J., Knudsen, T., & Rafaelsen, S. R. (2023) · Scandinavian Journal of Gastroenterology · doi:10.1080/00365521.2023.2234538 · Cited by 6
Self-citationMedical radiation exposure in inflammatory bowel disease: an updated meta-analysis
Lü, C., Yao, X., Yu, M., & He, X. (2024) · BMC Gastroenterology · doi:10.1186/s12876-024-03264-1 · Cited by 6
“Therefore, European Crohn’s and Colitis Organisation advocate increased routine usage of MRI for the assessment of small bowel CD [21].”
BackgroundThe use of ultrasound in colonic and perianal diseases
Fábián, A., Bor, R., & Szepes, Z. (2022) · Current Opinion in Gastroenterology · doi:10.1097/mog.0000000000000891 · Cited by 6
Weßling, J., Kucharzik, T. F., Bettenworth, D., Luegering, A., Maaser, C., Grenacher, L., Juchems, M. S., Ringe, K. I., Lauenstein, T. C., & Schreyer, A. G. (2023) · RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren · doi:10.1055/a-2036-7190 · Cited by 6
“The ECCO (European Crohnʼs and Colitis Organization) and ESGAR (European Society of Gastrointestinal and Abdominal Radiology) recently proposed the first joint reporting standards for MRI, CT, and bowel ultrasound [15].”
BackgroundSelf-citationIntestinal Ultrasound for Monitoring Colonic Inflammation in Inflammatory Bowel Disease
Chugh, R., Gu, P., & Dolinger, M. T. (2025) · Current Gastroenterology Reports · doi:10.1007/s11894-025-01010-5 · Cited by 5
“Normal BWT in the colon is considered ≤ 3 mm [6].”
Jairath, V., Adsul, S., Allocca, M., Danese, S., Dubinsky, M. C., de Oliveira, M. F., Ma, C., Kucharzik, T. F., Novak, K. L., Panaccione, R., et al. (2025) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaf196 · Cited by 5
Self-citationBapaye, J., Chandan, S., & Kochhar, G. S. (2024) · Gastrointestinal Endoscopy Clinics of North America · doi:10.1016/j.giec.2024.07.005 · Cited by 5
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Self-citationSvolos, V., Triantafyllou, A., Charmantzis, G., Delliou, M., Nanti, M.-N., Moustaka, M., Bakasieta, E., Balafa, E., Strongylou, D. E., & Androutsos, O. (2025) · Gastrointestinal Disorders · doi:10.3390/gidisord7040067 · Cited by 4
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“27 IUS is recommended as an ideal diagnostic tool for long-term follow-up of IBD according to both China and ECCO guidelines 28,29 Our AI approach could enhance the utility of this non-invasive imaging modality by providing objective, quantitative assessment of stricture characteristics.”
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Metadata
- Authors
- Kucharzik, T., Tielbeek, J., Carter, D., Taylor, S. A., Tolan, D., Wilkens, R., Bryant, R. V., Hoeffel, C., De Kock, I., Maaser, C., Maconi, G., Novak, K., Rafaelsen, S. R., Scharitzer, M., Spinelli, A., & Rimola, J.
- Affiliations
- Universität Hamburg (DE)
- Amsterdam University Medical Centers (NL)
- Tel Aviv University (IL)
- University College London (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- University of Copenhagen (DK)
- Queen Elizabeth Hospital (AU)
- Centre Hospitalier Universitaire de Reims (FR)
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
- Luigi Sacco Hospital (IT)
- University of Calgary (CA)
- Vejle Sygehus (DK)
- Medical University of Vienna (AT)
- Humanitas University (IT)
- Hospital Clínic de Barcelona (ES)
- Corresponding author
- Kucharzik, Torsten
- ORCID
- Venue
- Journal of Crohn's and Colitis
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-10-10
- Volume
- 16
- Issue
- 4
- Pages
- 523-543
- ISSN
- 1873-9946 (ISSN-L)
- 1876-4479
- OpenAlex
- W3206366357
- Cited by
- 149
- References
- 177
- Citations by year
- 2026: 35 · 2025: 50 · 2024: 28 · 2023: 26 · 2022: 10
- FWCI
- 2.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Crohn s and Colitis (publishedVersion, other-oa)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (acceptedVersion, other-oa)
- HAL (submittedVersion)
- Funders
- European Crohn’s and Colitis Organisation
- European Society of Gastrointestinal and Abdominal Radiology
- Topics
- Health Sciences › Medicine › Gastroenterology › Inflammatory Bowel Disease
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Keywords
- inflammatory bowel disease, cross-sectional imaging
- MeSH terms
- Gastroenterologists, Chronic Disease, Humans, Intestines, Magnetic Resonance Imaging, Ultrasonography, Inflammatory Bowel Diseases, Consensus
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