Practices and perceptions of imaging assessment in inflammatory bowel disease: a nationwide survey of physicians in Korea by the KASID Guidelines Taskforce Team

Background/Aims: Imaging-based assessment is essential for evaluating disease activity and structural damage in inflammatory bowel disease (IBD). This study aimed to evaluate real-world use and perceptions of imaging modalities among Korean IBD experts and to identify implications for future domestic guideline development. Methods: A nationwide, web-based survey was conducted among board-certified gastroenterologists affiliated with the Korean Association for the Study of Intestinal Diseases. The questionnaire assessed respondent characteristics, imaging modality use in Crohn’s disease (CD) and ulcerative colitis (UC), and perceptions of clinical utility using a 5-point Likert scale. Results were summarized as frequencies and percentages. Results: Of 150 invited clinicians, 133 responded, with 74.4% practicing in tertiary referral centers. In CD, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) were the most used modalities at diagnosis and follow-up. In contrast, IUS utilization was low (6.8% at diagnosis and 10.5% during follow-up), and 82.0% reported no intestinal ultrasound (IUS) use in the preceding year. In UC, CT-based strategies also predominated, and more than half reported no imaging during follow-up. Major barriers to IUS adoption included limited experience, time constraints, and institutional or equipment limitations. CT/CTE and MRE were perceived as useful for diagnosis and complication assessment, whereas IUS was viewed as suitable for repeated monitoring but highly operator dependent. Conclusions: IBD imaging practices in Korea rely predominantly on CT-based modalities, with limited real-world use of MRE and IUS despite their recognized clinical potential. Future Korean guidelines should acknowledge these real-world limitations while encouraging gradual integration of MRE and IUS.