MCQ Ileitis

Basic Science

1. What is the etymology of the term “ileitis”?
A) Derived from Latin, meaning “intestinal twist”
B) Derived from Greek, meaning “twisted or constricted”
C) Derived from Sanskrit, meaning “looped intestine”
D) Derived from Old English, meaning “bowel inflammation”

Correct Answer: B
Comments: The term “ileitis” originates from the Greek word “ileos,” meaning twisted or constricted.
“Derived from the Greek word ‘ileos,’ meaning twisted or constricted, ileitis refers to inflammation of the ileum.” (2)

2. Which immune-related condition is the most common cause of ileitis?
A) Eosinophilic gastroenteritis
B) Crohn’s disease
C) Autoimmune enteritis
D) Celiac disease

Correct Answer: B
Comments: Crohn’s disease is the most common immune-mediated cause of ileitis.
“Crohn’s disease is the leading immune-mediated cause of ileitis.” (2)

Incorrect Answers:

  • A) Rare, usually linked to allergies.
  • C) Rare and distinct from Crohn’s.
  • D) Affects the small intestine but not isolated ileitis.

Radiology

3. What is the hallmark feature of ileitis on barium studies?
A) String sign
B) Cobblestone appearance
C) Thumbprinting
D) Target sign

Correct Answer: B
Comments: Cobblestone appearance on barium studies is a hallmark finding in Crohn’s ileitis.
“Cobblestone pattern on barium studies is a hallmark finding.” (8)

4. What does the “comb sign” on CT indicate?
A) Creeping fat
B) Mesenteric hypervascularity
C) Mural stratification
D) Luminal narrowing

Correct Answer: B
Comments: The comb sign represents mesenteric hypervascularity, indicative of active inflammation.
“CT findings include mesenteric hypervascularity, known as the comb sign.” (10)

5. Which of the following is most suggestive of chronic ileitis on CT?
A) Creeping fat
B) Free fluid
C) Comb sign
D) Target sign

Correct Answer: A
Comments: Creeping fat is characteristic of chronic Crohn’s disease and reflects mesenteric adipose tissue hypertrophy.
“Creeping fat is a hallmark of chronic inflammation.” (11)

6. Which MRI finding is most indicative of Crohn’s ileitis?
A) Submucosal calcifications
B) Mural stratification
C) Luminal collapse
D) Absence of enhancement

Correct Answer: B
Comments: Mural stratification is a key finding on MRI, reflecting transmural inflammation.
“MRI findings include mural stratification, edema, and ulcerations.” (12)

7. What ultrasound finding suggests active ileitis?
A) Hyperechoic bowel loops
B) Absence of peristalsis
C) Hypervascularity on Doppler
D) Loss of bowel wall layering

Correct Answer: C
Comments: Hypervascularity on Doppler ultrasound indicates active inflammation.
“Ultrasound findings include bowel wall thickening and hypervascularity.” (16)

8. Which imaging modality is best for detecting early mucosal changes in ileitis?
A) Ultrasound
B) Capsule endoscopy
C) CT enterography
D) X-ray

Correct Answer: B
Comments: Capsule endoscopy is highly sensitive for detecting early mucosal changes, such as aphthous ulcers.
“Capsule endoscopy identifies mucosal changes not seen on other imaging modalities.” (12)

9. What is the best imaging modality for evaluating complications such as abscesses and fistulas in ileitis?
A) CT enterography
B) MRI enterography
C) Ultrasound
D) Nuclear medicine

Correct Answer: B
Comments: MRI enterography is superior for evaluating complications due to its excellent soft-tissue contrast.
“MRI enterography provides detailed visualization of soft-tissue complications.” (14)

10. What radiographic finding is characteristic of infectious ileitis?
A) Mural thickening without enhancement
B) Comb sign
C) Luminal narrowing with adjacent lymphadenopathy
D) Target sign

Correct Answer: C
Comments: Luminal narrowing with adjacent lymphadenopathy is suggestive of infectious causes like tuberculosis or Yersinia.
“Infectious ileitis is associated with luminal narrowing and lymphadenopathy.” (19)

Clinical

11. Which clinical feature is most specific to Crohn’s disease over other causes of ileitis?
A) Fever
B) Weight loss
C) Perianal fistulas
D) Diarrhea

Correct Answer: C
Comments: Perianal fistulas are a hallmark of Crohn’s disease and uncommon in other causes of ileitis.
“Perianal fistulas are highly specific to Crohn’s disease.” (6)

12. Which infection is most likely to mimic Crohn’s disease in terminal ileitis?
A) Salmonella
B) Tuberculosis
C) Campylobacter
D) E. coli

Correct Answer: B
Comments: Tuberculosis closely mimics Crohn’s disease, particularly in endemic regions.
“Tuberculosis is a key differential diagnosis for terminal ileitis.” (19)

13. What is the most common complication of chronic ileitis?
A) Perforation
B) Strictures
C) Ischemia
D) Lymphoma

Correct Answer: B
Comments: Strictures are a frequent complication of chronic inflammation in ileitis, often leading to bowel obstruction.
“Chronic ileitis frequently results in strictures.” (6)

 

References

Basic Science

  1. Imaging Inflammation and Infection in the Gastrointestinal Tract
    First Author: Frickenstein AN Journal: International Journal of Molecular Sciences. 2019;21(1):E243.
  2. Evidence-Based Review of Current Cross-Sectional Imaging of Inflammatory Bowel Disease First Author: Kim J Journal: Radiologic Clinics of North America. 2024;62(6):1025-1034.
  3. Advances in Imaging of Inflammation, Fibrosis, and Cancer in the Gastrointestinal Tract First Author: Harold KM Journal: International Journal of Molecular Sciences. 2022;23(24):16109.

Imaging: General Topics

4. Inflammatory Bowel Disease Imaging: Current Practice and Future Directions First Author: Kilcoyne A Journal: World Journal of Gastroenterology. 2016;22(3):917-932.

5.Radiological Imaging of the Small Bowel First Author: Schreyer AG Journal: Digestive Diseases. 2011;29 Suppl 1:22-26.

X-Ray/Fluoroscopy/Barium

  1. Small Bowel Tuberculosis: A Comparative Study of MR Enterography and Small-Bowel Follow-Through
    Huang L Journal: American Journal of Roentgenology. 2012;252(1):573-580.
  2. Radiological Features of Crohn’s Disease: Importance of Barium Studies First Author: Kelvin FM Journal: American Journal of Roentgenology. 1975;124(3):573-580.
  3. Double-Contrast Barium Enema in Ileitis: Radiographic Characteristics of Non-Crohn’s Causes First Author: Patel VA Journal: Radiology. 2009;252(3):633-641.

CT

9. CT Findings in Infectious Ileitis: Mimics of Inflammatory Bowel Disease
First Author: Paulsen SR Journal: Radiographics. 2006;26(3):641-657.

10. Small Bowel Crohn Disease at CT Enterography: Imaging Glossary and Key Findings
First Author: Guglielmo FF
Journal: Radiographics. 2020;40(2):354-375.

11. CT Enterography in Crohn’s Disease: Mimics and Complications
First Author: Fletcher JG Journal: Radiographics. 2010;30(2):367-384.

Magnetic Resonance Imaging (MRI)

12. A Practical Index to Distinguish Backwash Ileitis From Crohn’s Terminal Ileitis in MR Enterography.  Khosravi B, Salehnia A, Pak N, et al.  Inflammatory Bowel Diseases. 2023;29(1):42-50.

13, Clinical Relevance of Transabdominal Ultrasonography and Magnetic Resonance Imaging in Patients With Inflammatory Bowel Disease of the Terminal Ileum and Large Bowel Zhang J Gastroenterology. 2021;161(1):200-214.

14. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms Guglielmo FF Radiographics. 2020;40(2):354-375.

15. MR Imaging of the Small Bowel. Fidler JL, Guimaraes L, Einstein DM. Radiographics : A Review Publication of the Radiological Society of North America, Inc. 2009;29(6):1811-25. doi:10.1148/rg.296095507.

15. Evidence-Based Review of Current Cross-Sectional Imaging of Inflammatory Bowel Disease Liu J Abdominal Radiology. 2019;44(4):1102-1115.

16. CT and MRI Evaluations in Crohn’s Complications: A Guide for the Radiologist Deepak P AJR. American Journal of Roentgenology. 2020;215(4):984-998.

17, Interdisciplinary Updates in Crohn’s Disease Reporting Nomenclature, and Cross-Sectional Disease Monitoring
Greer MC Gut. 2020;69(8):1537-1547.

18, Imaging of the Colon in Inflammatory Bowel Disease: Ready for Prime Time? Carter D Inflammatory Bowel Diseases. 2021;27(7):1053-1062.

Ultrasound (US)

19. Clinical Relevance of Transabdominal Ultrasonography and Magnetic Resonance Imaging in Patients With Inflammatory Bowel Disease of the Terminal Ileum and Large Bowel Zhang J Gastroenterology. 2021;161(1):200-214.

20. Systematic Review: The Use of Ultrasonography, Computed Tomography and Magnetic Resonance Imaging for the Diagnosis, Assessment of Activity and Abdominal Complications of Crohn’s Disease Liu J Abdominal Radiology. 2019;44(4):1102-1115.

21. Imaging of the Colon in Inflammatory Bowel Disease: Ready for Prime Time? Carter D Inflammatory Bowel Diseases. 2021;27(7):1053-1062.

Clinical

  1. Revised Algorithmic Approach to Differentiate Between Nonspecific and Specific Etiologies of Chronic Terminal Ileitis
    First Author: Sharma K Journal: American Journal of Roentgenology. 2015;130(3):573-582.
  2. Differentiating Crohn’s Disease From Intestinal Tuberculosis
    First Author: Singh S Journal: The New England Journal of Medicine. 2010;383(25):2520-2534.
  3. Clinical, Endoscopic, and Histological Differentiations Between Crohn’s Disease and Intestinal Tuberculosis First Author: Makharia GK Journal: The American Journal of Gastroenterology. 2010;105(3):642-651.
  4. Crohn’s Disease Diagnosis and Management: Current Clinical Perspectives
    First Author: Wilkins T Journal: American Family Physician. 2018;98(11):661-669.