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Ulcerative Colitis
Atif Zaheer, MD; Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Ulcerative colitis (UC)
              • Definitions

                • Chronic, idiopathic, diffuse, inflammatory disease primarily involving colorectal mucosa

              IMAGING

              • General Features

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Podgórska J et al: Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study. Acta Radiol. 284185120931689, 2020
                                            2. Erden A et al: Backwash ileitis in ulcerative colitis: are there MR enterographic features that distinguish it from Crohn disease? Eur J Radiol. 110:212-8, 2019
                                            3. AlSabban Z et al: Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease? J Magn Reson Imaging. 47(6):1638-45, 2018
                                            4. Pouillon L et al: Diffusion-weighted MRI in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 3(6):433-43, 2018
                                            5. Bickston SJ et al: Vedolizumab for induction and maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 8:CD007571, 2014
                                            6. Gionchetti P et al: IBD. Sequential rescue therapy in steroid-refractory ulcerative colitis. Nat Rev Gastroenterol Hepatol. 11(9):521-3, 2014
                                            7. Lee YY et al: Are we ready for combination therapy in moderate-to-severe ulcerative colitis? Gastroenterology. 147(2):544, 2014
                                            8. Marineaţă A et al: Extra intestinal manifestations and complications in inflammatory bowel disease. Rev Med Chir Soc Med Nat Iasi. 118(2):279-88, 2014
                                            9. Patel NS et al: Outcomes of computed tomography and magnetic resonance enterography in clinical practice of inflammatory bowel disease. Dig Dis Sci. 59(4):838-49, 2014
                                            10. Reich KM et al: The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study. Aliment Pharmacol Ther. 40(6):629-38, 2014
                                            11. Hammer MR et al: Multidetector computed tomographic and magnetic resonance enterography in children: state of the art. Radiol Clin North Am. 51(4):615-36, 2013
                                            12. Hristova L et al: Colorectal cancer in inflammatory bowel diseases: CT features with pathological correlation. Abdom Imaging. 38(3):421-35, 2013
                                            13. Israeli E et al: The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 38(5):513-21, 2013
                                            14. Perlman SB et al: PET/CT imaging of inflammatory bowel disease. Semin Nucl Med. 43(6):420-6, 2013
                                            15. Swanson G et al: Diagnostic medical radiation in inflammatory bowel disease: how to limit risk and maximize benefit. Inflamm Bowel Dis. 19(11):2501-8, 2013
                                            16. Autenrieth DM et al: Toxic megacolon. Inflamm Bowel Dis. 18(3):584-91, 2012
                                            17. Kroeker KI et al: Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol. 45(1):34-9, 2011
                                            18. Lefèvre A et al: Multiple intra-abdominal venous thrombosis in ulcerative colitis: role of MDCT for detection. Clin Imaging. 35(1):68-72, 2011
                                            19. Sagara S et al: Acute respiratory distress syndrome associated with severe ulcerative colitis. World J Gastroenterol. 16(19):2440-2, 2010
                                            20. Yilmaz A et al: Pulmonary involvement in inflammatory bowel disease. World J Gastroenterol. 16(39):4952-7, 2010
                                            21. Ahmadi A et al: Colorectal cancer surveillance in inflammatory bowel disease: the search continues. World J Gastroenterol. 15(1):61-6, 2009
                                            22. da Luz Moreira A et al: Does CT influence the decision to perform colectomy in patients with severe ulcerative colitis?. J Gastrointest Surg. 13(3):504-7, 2009
                                            23. Haboubi N: Small bowel inflammation in ulcerative colitis. Colorectal Dis. 8(4):245-6, 2006
                                            24. Hanauer SB: New lessons: classic treatments, expanding options in ulcerative colitis. Colorectal Dis. 8 Suppl 1:20-4, 2006
                                            25. Hancock L et al: Inflammatory bowel disease: the view of the surgeon. Colorectal Dis. 8 Suppl 1:10-4, 2006
                                            26. Rutter MD et al: Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology. 130(4):1030-8, 2006
                                            27. Sandborn WJ: What's new: innovative concepts in inflammatory bowel disease. Colorectal Dis. 8 Suppl 1:3-9, 2006
                                            28. Carucci LR et al: Radiographic imaging of inflammatory bowel disease. Gastroenterol Clin North Am. 31(1):93-117, ix, 2002
                                            29. Horton KM et al: CT evaluation of the colon: inflammatory disease. Radiographics. 20(2):399-418, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Ulcerative colitis (UC)
                                                        • Definitions

                                                          • Chronic, idiopathic, diffuse, inflammatory disease primarily involving colorectal mucosa

                                                        IMAGING

                                                        • General Features

                                                          • Fluoroscopic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Podgórska J et al: Intravoxel incoherent motion MRI in evaluating inflammatory activity in ulcerative colitis: a pilot study. Acta Radiol. 284185120931689, 2020
                                                                                      2. Erden A et al: Backwash ileitis in ulcerative colitis: are there MR enterographic features that distinguish it from Crohn disease? Eur J Radiol. 110:212-8, 2019
                                                                                      3. AlSabban Z et al: Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease? J Magn Reson Imaging. 47(6):1638-45, 2018
                                                                                      4. Pouillon L et al: Diffusion-weighted MRI in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 3(6):433-43, 2018
                                                                                      5. Bickston SJ et al: Vedolizumab for induction and maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 8:CD007571, 2014
                                                                                      6. Gionchetti P et al: IBD. Sequential rescue therapy in steroid-refractory ulcerative colitis. Nat Rev Gastroenterol Hepatol. 11(9):521-3, 2014
                                                                                      7. Lee YY et al: Are we ready for combination therapy in moderate-to-severe ulcerative colitis? Gastroenterology. 147(2):544, 2014
                                                                                      8. Marineaţă A et al: Extra intestinal manifestations and complications in inflammatory bowel disease. Rev Med Chir Soc Med Nat Iasi. 118(2):279-88, 2014
                                                                                      9. Patel NS et al: Outcomes of computed tomography and magnetic resonance enterography in clinical practice of inflammatory bowel disease. Dig Dis Sci. 59(4):838-49, 2014
                                                                                      10. Reich KM et al: The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study. Aliment Pharmacol Ther. 40(6):629-38, 2014
                                                                                      11. Hammer MR et al: Multidetector computed tomographic and magnetic resonance enterography in children: state of the art. Radiol Clin North Am. 51(4):615-36, 2013
                                                                                      12. Hristova L et al: Colorectal cancer in inflammatory bowel diseases: CT features with pathological correlation. Abdom Imaging. 38(3):421-35, 2013
                                                                                      13. Israeli E et al: The impact of abdominal computed tomography in a tertiary referral centre emergency department on the management of patients with inflammatory bowel disease. Aliment Pharmacol Ther. 38(5):513-21, 2013
                                                                                      14. Perlman SB et al: PET/CT imaging of inflammatory bowel disease. Semin Nucl Med. 43(6):420-6, 2013
                                                                                      15. Swanson G et al: Diagnostic medical radiation in inflammatory bowel disease: how to limit risk and maximize benefit. Inflamm Bowel Dis. 19(11):2501-8, 2013
                                                                                      16. Autenrieth DM et al: Toxic megacolon. Inflamm Bowel Dis. 18(3):584-91, 2012
                                                                                      17. Kroeker KI et al: Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol. 45(1):34-9, 2011
                                                                                      18. Lefèvre A et al: Multiple intra-abdominal venous thrombosis in ulcerative colitis: role of MDCT for detection. Clin Imaging. 35(1):68-72, 2011
                                                                                      19. Sagara S et al: Acute respiratory distress syndrome associated with severe ulcerative colitis. World J Gastroenterol. 16(19):2440-2, 2010
                                                                                      20. Yilmaz A et al: Pulmonary involvement in inflammatory bowel disease. World J Gastroenterol. 16(39):4952-7, 2010
                                                                                      21. Ahmadi A et al: Colorectal cancer surveillance in inflammatory bowel disease: the search continues. World J Gastroenterol. 15(1):61-6, 2009
                                                                                      22. da Luz Moreira A et al: Does CT influence the decision to perform colectomy in patients with severe ulcerative colitis?. J Gastrointest Surg. 13(3):504-7, 2009
                                                                                      23. Haboubi N: Small bowel inflammation in ulcerative colitis. Colorectal Dis. 8(4):245-6, 2006
                                                                                      24. Hanauer SB: New lessons: classic treatments, expanding options in ulcerative colitis. Colorectal Dis. 8 Suppl 1:20-4, 2006
                                                                                      25. Hancock L et al: Inflammatory bowel disease: the view of the surgeon. Colorectal Dis. 8 Suppl 1:10-4, 2006
                                                                                      26. Rutter MD et al: Thirty-year analysis of a colonoscopic surveillance program for neoplasia in ulcerative colitis. Gastroenterology. 130(4):1030-8, 2006
                                                                                      27. Sandborn WJ: What's new: innovative concepts in inflammatory bowel disease. Colorectal Dis. 8 Suppl 1:3-9, 2006
                                                                                      28. Carucci LR et al: Radiographic imaging of inflammatory bowel disease. Gastroenterol Clin North Am. 31(1):93-117, ix, 2002
                                                                                      29. Horton KM et al: CT evaluation of the colon: inflammatory disease. Radiographics. 20(2):399-418, 2000