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There is a growing need for biomarkers to predict therapeutic outcome in Crohn's disease (CD).The aim was to evaluate whether NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), ELR (eosinophil-to-lymphocyte ratio), and ENLR (eosinophil*neutrophil-to-lymphocyte ratio), could be prognostic biomarkers of endoscopic response (ER) when starting biologics.Patients with CD who started biologics were enrolled. Multivariate analysis was used to evaluate whether NLR, PLR, ELR and ENLR at baseline and at w12 could predict ER (Simple Endoscopic Score for Crohn's disease [SES-CD] ≤2 or SES-CD≤2 and Rutgeerts i0-i1) after 52 weeks of treatment. Area under the curve (AUC) was calculated to find the cutoffs.107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013), and ENLR (p = 0.020) compared with those without ER; results after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.003). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR.Low NLR, ELR and ENLR can predict ER and could be used in clinical practice for a better management of CD patients.

The Coronavirus Disease 2019 (COVID-19) represents the first medical catastrophe of the new millennium. Although imaging is not a screening test for COVID-19, it plays a crucial role in evaluation and follow-up of COVID-19 patients. In this paper, we will review typical and atypical imaging findings of COVID-19.

Behçet’s disease is a chronic and multisystemic inflammatory vascular disease of unknown etiology, affecting vessels of all kinds and sizes. The involvement of the vascular system is observed in approximately 5-30% of patients. The most frequent vascular manifestations are venous thrombosis followed by arterial aneurysms and arterial thrombosis. The identification of vascular involvement is very important for prognosis, indeed the rupture of an arterial aneurysm represents the leading cause of sudden death in patients with Behçet’s disease. Computed tomography (CT) plays a crucial role in the identification and in the follow-up of vascular involvement. In this paper, we report the case of a 42-year-old woman with Behçet’s disease, admitted to our emergency department for hemoptysis, showing pulmonary and visceral artery aneurysms identified at CT examination. A particular “string of beads” appearance of pulmonary arteries is described. We report, also, follow-up CT examination after medical therapy showing pulmonary artery aneurysms reduction and visceral artery aneurysms stability.

Superior mesenteric artery (SMA) syndrome is an infrequent cause of vomiting and weight loss due to compression of the third part of the duodenum by the SMA. We describe the case of a 17-year-old woman, admitted to our department for progressive dysphagia and severe weight loss due to an oesophageal peptic stricture, caused by chronic acid reflux secondary to duodenal compression by the SMA. Symptoms improved after (par)enteral nutrition and repeated oesophageal dilatation, thus supporting the role of intensive medical and endoscopic intervention as an alternative to surgery, at least in some cases.

This paper examines the diagnostic potential of multislice computed tomography enteroclysis (MSCT-E) to detect and assess different diseases affecting the small bowel, emphasising the increasingly important role assumed by the technique in the study of this anatomical region. After a short summary of the technical aspects, we discuss the different findings that can be observed during an MSCT-E study and that enable detection of small-bowel disease and, if necessary, assessment of the extent and stage of disease.

Inflammatory bowel diseases are associated with an increased risk of vascular complications. The most important are arterial and venous thromboembolisms, which are considered as specific extraintestinal manifestations of inflammatory bowel diseases. Among venous thromboembolism events, portal vein thrombosis has been described in inflammatory bowel diseases. We report three cases of portal vein thrombosis occurring in patients with active inflammatory bowel disease. In two of them, hepatic abscess was present. Furthermore, we performed a systematic review based on the clinical literature published on this topic.

The term Inflammatory Bowel Disease (IBD) is used to describe several idiopathic gastrointestinal disorders; among these diseases, the most commonly encountered in clinical practice are Crohn’s Disease (CD) and Ulcerative Colitis (UC). CD and UC are different both in distribution of gastrointestinal tract involvement and depth of inflammation. 25% of patients reveals IBD during childhood or adolescence. [1] No consensus exists regarding the optimal techniques and imaging modalities when evaluating IBD, especially in the paediatric age. [2] The correct imaging choice often depends on clinical presentation of patients. The most common situations are: the initial diagnosis of suspected IBD; patients with known IBD presenting with acute symptoms; follow-up of patients with or without new symptoms. [2] Multiple methods can be used to diagnose and examine paediatric patients with IBD, including Computed Tomography (CT), Magnetic Resonance (MR), Small Bowel Follow-through radiographic examination (SBFT), Endoscopy, and Ultrasound (US). [3,4] While UC is mainly clinically managed with endoscopy and US, CD very often needs cross-sectional imaging to assess the exact distribution and activity of the disease, and to detect extraluminal complications (phlegmon, abscess, fistula, bowel perforation). Due to early onset of disease, paediatric patients obviously need additional attention to minimize radiation exposure: it is mandatory to avoid unnecessary ionizing radiation techniques in IBD imaging. [2-4] Consequence of the foregoing statements, US and (more recently) MR-enterography have become the preferred imaging modalities in management of young patients with IBD. [2-6] In clinical practice, in Europe, US is currently the first examination requested to evaluate patients with abdominal symptoms. US is accurate in diagnosis of several paediatric (intestinal and non-intestinal) diseases; US may also help when selecting patients needing additional caring among children suffering from gastroenteric tract diseases. [5] Furthermore, US may offer information that are difficult to obtain with other diagnostic modalities, and in fact it is the only technique which could possibly investigate in real time all the followings: the morphological and functional aspects of the bowel wall, the vascularisation (with color-Doppler) of thickened bowel, the stiffness of intestinal loops, and perivisceral spaces. [5] The aim of this review is to elucidate the current role of US in diagnosis and follow-up of paediatric patients with UC and CD, and to discuss the advantages and disadvantages of this radiation-free imaging methods in terms of cost, safe, diagnostic accuracy and accessibility compared with other diagnostic modalities.