**4. Conclusions**

*Endoscopy in Small Bowel Diseases*

of abdominal diseases [48–54].

with high radiation.

**Figure 14.**

**3. What is the new gold standard?**

*ileal wall with visible free water diffusion restriction.*

allows the assessment of the disease activity.

it depends on the experience of the doctor.

the assessment of perianal fistulas [61].

With this imaging technique, the whole signal from the tissue is canceled, so that only the signal of the molecules moving due to diffusion is displayed. The method is very demanding for the device, and only devices with good, strong, and fast gradients can cancel the signal enough not to see the "illumination of the T2 image", which can be sensed even with robust devices. These images are used daily to show the brain tissue that has experienced ischemia or stroke. Although the information obtained by diffusion measurements requires new studies, several reports have shown that diffusion imaging could become a powerful principle for the diagnosis

*(A) T2 blade transverse mbh, (B) T1 vibe fs transverse mbh, (C) DWI and (D) ADC map: Thickening of the* 

Barium contrast tests and isotopes have been used to show inflammatory bowel disease, but they carry a risk of ionizing radiation exposure. Barium use is declining to result in fewer radiologists having the expertise and experience for such examinations - the lack of anatomical localizations limits isotopic studies. CT is beneficial for assessing Crohn's disease complications, but it is burdened

CT enterography improves the visualization of the small bowel disease and

Ultrasound has been increasingly used for the preliminary assessment of patients with potential IBD [55–59]. Although it is widely available and inexpensive,

Finally, MRI is the most accurate tool for assessing the disease, its severity, and its prevalence [42–44, 60]. Pelvic MRI completely suppressed other techniques in

According to the latest ECCO guidelines for the diagnosis of Crohn's disease, endoscopy and radiology are complementary techniques to define the site and

extension of the disease so that optimal therapy can be planned [62].

**18**

Conventional ultrasound is a suitable orientation method in the initial evaluation of the patients with Crohn's disease. It can be used as an initial method for the patients who will subsequently undergo MRI enterography. CT is beneficial for assessing Crohn's disease complications, but it is burdened with high radiation.

Contrast MRI enterography provides an excellent assessment of disease activity, as well as the complications that accompany it. The method has a high sensitivity to changes seen in the patients with Crohn's disease; it offers detailed morphological and functional data on the small bowel disease and reliable evidence of normalcy; thus, it facilitates the final diagnosis of early or subtle structural abnormalities and helps to guide treatment and decisions on a further follow-up of patients. Contrast MRI enterography, in combination with DWI, is a comprehensive and safe method compared to reference - endoscopic examinations, and it should be considered as the preliminary examination for the detection of lesions in Crohn's disease, especially in children. Given the convenience and considering the safety and ease of the analysis, MRI enterography combined with DWI is suitable for repeated followup examinations, i.e. it can contribute to the follow-up of patients with Crohn's disease. Contrast MRI enterography combined with DWI is an excellent tool for evaluating complications of the underlying condition, especially for detecting fistulas, perianal fistulas in particular.
