著名学者天然自然地暴露在一小部分全球人口日益增加的种群中会引发著名为乳糜泻的免疫介导性小肠疾病，该疾病源于对麸质过敏的遗传易感个体。然而，乳糜泻的患病率会随着年龄、性别和地理位置的不同而产生变化。当前，严格的无麸质饮食仍然是乳糜泻的首选治疗方法。绝大多数乳糜泻患者对无麸质饮食有良好的反应，预后良好，但是一些患者无法缓解症状或实现组织学缓解（如非反应性或难治性乳糜泻）。由于临床表现的异质性，乳糜泻的诊断是困难的。此外，伴随难治性乳糜泻的恶性并发症和不良预后给疾病管理带来了巨大的挑战。过去三十年来，断层成像技术（计算机断层扫描[CT]和磁共振成像[MRI]）在小肠炎症和肿瘤性疾病的诊断中起着重要的作用。与内窥镜技术相比，断层成像可以清晰显示腔内腔外异常情况。它提供血管和功能信息，从而提高了作为诊断和随访工具的可能性。断层成像对疑似或已确认的乳糜泻患者的价值已逐渐得到证明。研究表明，断层成像提示的某些特征有助于早期乳糜泻的诊断。此外，断层成像的潜在贡献可能在于评估疾病活动和严重程度，从而指导管理策略。本综述的目的是提供当前对成人乳糜泻断层成像的综述和未来发展方向，以促进对临床实践的理解和应用。临床相关性述评：在本文综述中，我们系统总结了成人乳糜泻断层成像的现有知识，并分析了其在临床实践中可能扮演的角色，包括疾病诊断、并发症鉴别、治疗评估和预后预测。关键要点：• 从「乳糜冰山」的描述来看，乳糜泻仍然被低估和治疗不足。• 断层成像在乳糜泻的临床管理中是有帮助的，包括疾病诊断、并发症鉴别、治疗评估和预后预测。• 断层成像应被视为对怀疑乳糜泻患者的有价值的检查方法。 © 2023年作者，欧洲放射学会独家许可使用。

Celiac disease (CD), triggered by exposure to gluten in genetically susceptible individuals, is an immune-mediated small bowel disease affecting about 1% of the population worldwide. But the prevalence of CD varies with age, sex, and location. A strict gluten-free diet remains the primary treatment for CD, currently. Most of patients with CD respond well to gluten-free diet with good prognosis, while some patients fail to get symptomatic relief or histological remission (e.g., nonresponsive or refractory CD). Because of heterogeneous clinical appearance, the diagnosis of CD is difficult. Moreover, malignant complications and poor outcomes accompanied with refractory CD present great challenges in disease management. Over the past three decades, cross-sectional imaging techniques (computed tomography [CT] and magnetic resonance imaging [MRI]) play an important role in small bowel inflammatory and neoplastic diseases. Compared with endoscopic techniques, cross-sectional imaging permits clearly presentation of both intraluminal and extraluminal abnormalities. It provides vascular and functional information, thus improving the possibility as diagnostic and follow-up tool. The value of cross-sectional imaging for patients with suspected or confirmed CD has been gradually demonstrated. Studies revealed that certain features suggested by cross-sectional imaging could help to establish the early diagnosis of CD. Besides, the potential contributions of cross-sectional imaging may lie in the evaluation of disease activity and severity, which helps guiding management strategies. The purpose of this review is to provide current overviews and future directions of cross-sectional imaging in adult CD, thus facilitating the understanding and application in clinical practice. CLINICAL RELEVANCE STATEMENT: In this review, we systematically summarized the existing knowledge of cross-sectional imaging in adult CD and analyzed their possible roles in clinical practice, including disease diagnosis, complication identification, treatment evaluation, and prognostic prediction. KEY POINTS: • Regarding a condition described as "celiac iceberg", celiac disease remains underdiagnosed and undertreated. • Cross-sectional imaging is helpful in clinical management of celiac disease, including disease diagnosis, complication identification, treatment evaluation, and prognostic prediction. • Cross-sectional imaging should be considered as the valuable examination in patients suspected from celiac disease.© 2023. The Author(s), under exclusive licence to European Society of Radiology.