Evolving role of intestinal ultrasound in the evaluation of Crohn's disease: A clinical- radiological perspective

This review examines the recent increase in both clinical and radiological interest in ultrasound in inflammatory bowel disease (IBD), with particular emphasis on its role in the assessment of Crohn's disease. Intestinal ultrasound (IUS) has emerged as an attractive imaging modality because of its non-invasive nature, safety, repeatability, low cost, and ability to provide real-time assessment of IBD. In recent years, its adoption has expanded considerably, particularly among gastroenterologists, supported by increasing evidence demonstrating its high diagnostic accuracy for evaluating Crohn's disease activity, extent, and complications, particularly at the level of the terminal ileum. At the same time, several limitations remain, including strong operator dependency, variability in expertise, limited assessment of certain bowel segments, and the absence of universally standardized training and certification pathways, particularly outside radiology. This review critically discusses the main strengths and weaknesses of IUS when applied to Crohn's disease, highlighting its current role within a multimodal diagnostic strategy and its integration with endoscopy and cross-sectional imaging.