The rising incidence of inflammatory bowel disease (IBD) and the growth of our aging population are contributing to a rapidly increasing number of elderly IBD patients. Approximately 10–15% of new IBD diagnoses occurs among older patients (>60 years). Unfortunately, 60% of elderly patients with IBD are initially misdiagnosed, as opposed to 15% of younger patients. Comorbid illness in older patients often has a significant impact on the outcome of medical and surgical therapy for IBD, but, in the absence of significant comorbid disease, most elderly IBD patients can expect a good response to therapy. Diagnostic work-up in elderly IBD does not significantly differ from other adult patients. However, the differential diagnosis is more different in the elderly. The understanding of radiologic features of IBD and other disorders that can complicate disease in the elderly is challenging. The use of advanced radiological examinations including US and cross-sectional imaging (CT and MRI) is useful for a correct diagnosis, to exclude other causes of disease, to prompt identity complications, and to monitor response to therapies. In this chapter, we compare the relative performance of the diagnostic technologies in detecting IBD, focusing on their advantages and disadvantages in elderly IBD patients and how they might complement each other.