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The diagnostics of small bowel diseases represent a special challenge as this intestinal segment is not readily accessible endoscopically and the clinical symptoms are often nonspecific. The assessment is further complicated by the bowel motility and the dependency on contrast agent administration and luminal distension. Modern cross-sectional imaging techniques, particularly computed tomography (CT) and magnetic resonance (MR) enterography, have revolutionized the diagnostics of inflammatory, neoplastic and vascular small bowel diseases. The precise differentiation of the various small bowel pathologies requires thorough knowledge of characteristic imaging patterns. Bowel wall thickening, the extent, distribution and pattern of contrast enhancement uptake, mesenteric vascular changes and associated extraintestinal findings provide crucial diagnostic indications. The integration of clinical parameters with morphological and functional imaging criteria enables timely and targeted treatment planning.