| Abstract | Upalne crijevne bolesti (UCB) su kronične bolesti gastrointestinalnog trakta, odnosno pojedinih njegovih dijelova, tankog i debelog crijeva, koje su klinički obilježene remisijama i egzacerbacijama. Dva glavna oblika ovih upalnih bolesti su ulcerozni kolitis i Crohnova bolest. Dijagnoza ovih bolesti temelji se na: kliničkoj slici, laboratorijskim nalazima, nalazu endoskopije, patohistološkom nalazu i u novije vrijeme na suvremenim radiološkim metodama dijagnostike crijeva. U inicijalnoj dijagnostici endoskopija je metoda izbora, s obzirom na to da omogućuje uzimanje materijala za patohistološku analizu stijenke crijeva. Za razliku od endoskopskih metoda radiološke tehnike su manje invazivne, zahtijevaju manje vremena za izvođenje pregleda i omogućuju oslikavanje cijelog probavnog trakta. Radiološke metode se zato koriste u procjeni proširenosti i karakteristika bolesti (upalna vs. fibrostenotička) te praćenju učinka terapije i praćenju bolesnika. U akutnim stanjima radiološke metode otkrivaju intraabdominalne komplikacije bolesti poput perforacije crijeva, fistula i apscesa. Konvencionalne radiološke metode, pasaža tankog crijeva i irigografija, danas su napuštene zbog niske senzitivnosti i specifičnosti te izlaganja pacijenata većim dozama ionizirajućeg zračenja. Uvođenjem slojevnih metoda oslikavanja: računalne tomografije (CT) i magnetske rezonancije (MR), omogućen je prikaz promjena sluznice, intraluminalnih promjena, muralnih i ekstramuralnih manifestacija bolesti te ekstraintestinalnih komplikacija. CT uređaji su široko dostupni, a CT-om se u svega nekoliko minuta snimanja dobija cijeloviti prikaz abdominalnih organa, bez značajnijih artefakata gibanja ili peristaltike. CT enterografija i CT kolonografija su visoko osjetljive i specifične metode u dijagnostici i praćenju bolesti. Primjena ionizirajućeg zračenja njihov je najveći nedostatak, stoga se u djece i pacijenata u reproduktivnoj dobi zamjenjuju neionizirajućim metodama: MR enterografijom i MR enterokolonografijom. Zahvaljujući boljoj kontrastnoj rezoluciji, mogućnosti statičkog i dinamičkog oslikavanja, uporabi različitih sekvenci, multiplanarnog prikaza, relativno sigurnim intravenskim paramagnetskim kontrastima, osobito uz razvoj novih tehnika snimanja koje ne zahtijevaju uporabu intravenskog kontrasta, dijagnostička točnost MR metoda je ista ili čak veća u usporedbi s CT-om. Ograničenja MR su: visoka cijena, manja dostupnost uređaja i educiranih radiologa, varijabilnost u kvaliteti snimki ovisno o suradljivosti bolesnika, manja prostorna i vremenska rezolucija u odnosu na CT, nemogućost snimanja bolesnika s metalnim implantatima i klaustrofobija. Stoga je u akutnim stanjima CT metoda izbora za bolesnike s UCB. |
| Abstract (english) | Inflammatory bowel diseases (IBD) are chronic diseases of the gastrointestinal tract, or parts of it, the small and large intestine, which are clinically characterized by remissions and exacerbations. Two major forms of these inflammatory diseases are ulcerative colitis and Crohn's disease. The diagnosis of these diseases is based on clinical presentation, laboratory findings, endoscopy findings, pathohistological findings and, more recently, modern radiological methods of bowel diagnostics. In initial diagnosis, endoscopy is the method of choice, since it allows material to be collected for pathohistological analysis of the bowel wall. Unlike endoscopic methods, radiological techniques are less invasive, require less time to perform examinations, and allow imaging of the entire digestive tract. Radiological methods are therefore used in the assessment of the spread and characteristics of the disesase (inflammatory vs. fibrostenotic), monitoring the effect of therapy, and monitoring patients. In acute conditions, radiological methods reveal intra-abdominal complications of diseases such as bowel perforation, fistulas, and abscesses. Conventional radiological methods, small bowel follow-throughs and barium enemas, have been abandoned today due to low sensitivity and specificity, and exposure of patients to higher doses of ionizing radiation. The introduction of cross-sectional imaging methods: computed tomography (CT) and magnetic resonance imaging (MR), has enabled the presentation of mucosal changes, intraluminal changes, mural and extramural manifestations of the disease, and extraintestinal complications. CT devices are widely available, and CT imaging provides a complete view of the abdominal organs within minutes of imaging, without significant movement or peristaltic artifacts. CT enterography and CT colonography are highly sensitive and specific methods in the diagnosis and monitoring of disease. The use of ionizing radiation is their biggest disadvantage, and they are therefore replaced by non-ionizing methods in children and patients of reproductive age: MR enterography and MR enterocolonography. Thanks to better contrast resolutions, static and dynamic imaging capabilities, the use of different sequences, multiplanar imaging, relatively safe intravenous paramagnetic contrasts, especially with the development of new imaging techniques that do not require intravenous contrasts, the diagnostic accuracy of the MR methods is the same or even better compared to the CT one. The limitations of MR are high cost, lower availability of devices and trained radiologists, variability in imaging quality depending on patient compliance, lower spatial and temporal resolution compared to CT, and an inability to image patients with metal implants and claustrophobia. Therefore, in acute conditions, CT is the method of choice for patients with IBD. |
