Imaging in discriminating intestinal tuberculosis and Crohn’s disease: past, present and the future

ABSTRACT

Introduction: Intestinal tuberculosis (ITB) and Crohn’s disease (CD) have similar clinical presentation, but require different treatment approaches. Despite advances in various endoscopic, imaging, microbiological, and histological techniques, the differentiation of these two entities is often difficult. Newer radiological and image acquisition modalities have now become indispensable tools for evaluation of these two diseases.

Areas covered: This review summarizes the currently available literature on various radiological investigations to differentiate ITB from CD. This review also enumerates the newer modalities in image acquisition techniques and their potential role for differentiating these two diseases. At present abdominal computed tomography (CT) scan is used as a first line investigation for differentiating ITB from CD. Magnetic resonance imaging (MRI) is preferred in pediatric patients and for follow-up studies.

Expert opinion: Role of newer modalities like contrast enhanced abdominal ultrasound, perfusion CT, advanced MRI and positron emission tomography (PET) is evolving and requires further exploration. Till further robust studies are available, differentiation between ITB and CD requires use of a combination of clinical, endoscopic, serological, histological, and radiological parameters rather than relying on a single test.

KEYWORDS:

• Computed tomography
• colonoscopy
• tuberculosis
• gastrointestinal
• serology
• response to therapy
• stricture

Article highlights

• Intestinal tuberculosis and Crohn’s disease have a similar clinical presentation, imaging and histological findings. The differentiation between the two is a difficult clinical challenge.

• Various radiological modalities play an essential role in evaluation of these diseases and may have a role in differentiating these two conditions in clinical practice.

• Abdominal computed tomography is often used as a first line investigation for evaluation of these conditions. However, Magnetic resonance imaging (MRI) may be preferable in pediatric patients and for follow-up studies for assessing response to therapy.

• Newer imaging modalities like contrast enhanced intestinal ultrasound, perfusion MRI and PET/CT need to be evaluated for discrimination of these two conditions.

Acknowledgments

Authors would like to acknowledge the input of Victoria Chernyak, MD MS, Professor of Radiology and Urology, Director of Body MR Imaging, Montefiore Medical Center/AECOM, Bronx, NY, USA for providing the MRI images.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.