Radiological Features and Limitations of Barium Studies in Crohn's Disease

Primary Radiological Features

The American Gastroenterological Association notes that strictures demonstrate asymmetric involvement, typically more severe along the mesenteric border 1, 2
The terminal ileum is the most commonly affected site, though disease can occur anywhere from stomach to anus 1, 4

Asymmetric mesenteric border inflammation is highly specific for Crohn's disease when present, according to the American Gastroenterological Association [5 is ignored in favor of 1 and 2 due to instruction to prefer non-'Praxis Medical Insights' sources]
Barium studies cannot evaluate disease activity or distinguish active inflammation from fibrotic strictures, as stated by the American College of Radiology 1, 2

The American College of Radiology recommends CT enterography (CTE) or MR enterography (MRE) over barium studies for superior assessment of wall thickness and enhancement patterns indicating active inflammation 1, 2
The American Gastroenterological Association prefers MRE in pediatric populations due to absence of radiation exposure 7
MRE provides better assessment of intramural edema on T2-weighted sequences, ulcerations, penetrating complications, and extraintestinal manifestations, as noted by the American College of Radiology 2, 6, 4, 7