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The role of imaging in small bowel disease

¹ Department of Radiology, Great Western Hospital, Marlborough Road, Swindon, Wiltshire SN3 6BB, ² Department of Radiology, Royal United Hospital, Combe Park, Bath BA1 3NG, ³ Department of Radiology, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK

• A successful small bowel imaging strategy depends on choosing the right investigation to answer the right clinical question.
  
• Barium studies are readily available, reproducible, easy to perform, consistent and currently the workhorse in the investigation of small bowel disease.
  
• CT enteroclysis (CTE) and MR enteroclysis (MRE) provide both luminal and extraluminal information during a single examination.
  
• MRE, in particular, is a low radiation dose study and an attractive imaging option when investigating Crohn's disease in young patients.
  
• Wireless capsule endoscopy (WCE) is considered more sensitive than barium and CT for small mucosal lesions and obscure gastrointestinal (GI) bleeding.
  
• Radionuclide studies are best employed when a specific diagnosis is suspected.
  

The small bowel represents the most challenging part of the alimentary canal to image. A successful imaging strategy is dependent on using the most appropriate radiology to answer the right clinical question. A number of conventional imaging strategies, such as barium follow-through, have been successfully used to characterize small bowel pathology, but newer techniques, including CT enteroclysis or MR enteroclysis (CTE or MRE) and wireless capsule endoscopy (WCE), have been introduced and are gaining popularity. The purpose of this review is to describe and fully illustrate the different imaging modalities and techniques currently available in the investigation of small bowel disease. We will assess the strengths and weaknesses of each test and highlight their most appropriate use.