Role of non-invasive imaging in the diagnosis and management of patients with suspected and established IBD

In a treat to target era, objective disease assessment in inflammatory bowel disease (IBD) has become increasingly important. For many years, endoscopy has been generally accepted as the gold standard for evaluating the bowel mucosa, additionally facilitating biopsy. However, non-invasive disease assessment is now increasingly demanded and cross-sectional imaging techniques as well as video capsule endoscopy have markedly improved. Emerging evidence demonstrates the added clinical value of transmural assessment both in Crohn’s disease and ulcerative colitis, and cross-sectional imaging modalities are increasingly used in phenotyping and monitoring IBD patients. In the current review we propose potential algorithms to use non-invasive imaging in various clinical scenarios and for use in daily practice. The readers will come away with an understanding of what imaging they should consider for different clinical situations and the strengths and limitations of each modality. Future developments of non-invasive diagnostic strategies and areas in need of further research are highlighted.