Diagnostic imaging and radiation exposure in inflammatory bowel disease

Zakeri, Nekisa; Pollok, Richard

doi:10.3748/wjg.v22.i7.2165

Cited by 50 publications

(43 citation statements)

References 71 publications

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“…11,12 However, retrospective studies have confirmed that both adults and children with CD may have high levels of cumulative exposure to diagnostic ionizing radiation, drawing attention to the need for alternative, accurate, radiation-free techniques. [13][14][15][16][17] In view of this, magnetic resonance enterography (MRE) is now more frequently used to assess pediatric CD, providing an accurate tool to assess disease extent and distribution, depicting both intestinal and extraintestinal disease-related complications. 18 It is favored due to its inherent multiplanar capability and ability to provide excellent soft-tissue contrast resolution without exposure to ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

et al. 2019

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Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CD‐related complications were assessed using kappa (κ) coefficient statistics. A total of 93 patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ = 0.73) but fair in TUS (κ = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ = 0.63) and moderate (κ = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ = 0.77) and dilatation (κ = 0.68). Conclusions SICUS offers a radiation‐free alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.

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Section: Introductionmentioning

confidence: 99%

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

et al. 2019

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“…The diagnosis is made based on well‐described clinical, endoscopic, histological, radiological and biochemical parameters. Delayed access to cross‐sectional imaging and colonoscopy due to long waiting lists is a significant barrier to early diagnosis and the initiation of medical management . The median duration from the time of symptoms onset to diagnosis has been reported in some series to be up to 24 months .…”

Section: Introductionmentioning

confidence: 99%

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

Shen

Lord

Doecke

et al. 2019

Aliment Pharmacol Ther

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Summary Background Delays in Crohn's disease (CD) diagnosis are positively associated with ileal location and an increased risk of complications. Aim To develop a simple risk assessment tool to enable primary care physicians to recognise potential ileal CD earlier, shortening the delay to specialist investigation Methods Three cohorts were acquired for this study. Cohort 1 included 61 patients retrospectively identified with ileal CD between 2000 and 2010 and 78 matched controls drawn from a cohort referred for investigation of abdominal symptoms. Cohort 2 included 42 individuals diagnosed with ileal CD and 57 controls identified prospectively. Cohort 3 included an additional 84 individuals with ileal CD and 495 without CD referred for colonoscopy. Clinical symptoms and serological biomarkers were acquired and used to develop a risk prediction algorithm. The algorithm was trained independently on each of the three cohorts and tested on the latter two cohorts. Results Altered bowel habit with abdominal pain combined with derangements in white cell count (WCC), albumin and platelet counts were important features in predicting ileal CD (AUC = 0.92, 95% CI = 0.89‐0.92). This was validated in cohorts 2 (AUC = 0.96, 95% CI = 0.95‐0.98) and 3 (AUC = 0.94, 95% CI = 0.92‐0.96). C‐reactive protein was independently associated with ileal CD but non‐signficant in a multivariate model. Conclusion A web‐based risk stratification tool for ileal CD has been developed from objective and symptom‐based criteria. This tool enables primary care physicians to more confidently request urgent specialist assessment for patients identified as at high risk for ileal CD.

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“…The majority of these patients are young people and require frequent monitoring, considering the course of these disorders; that is why an additional non-invasive, well tolerated and confident diagnostic tool for the assessment of IBD evolution is required. There is no gold standard imagistic technique for the diagnosis and follow-up of IBD, but computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) provide important information regarding intestinal alteration and extraintestinal manifestations [16][17][18]. Abdominal US techniques have the advantage of being radiationsparing, non-invasive, well tolerated, cheap and easily repeated.…”

Section: Introductionmentioning

confidence: 99%

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

Marin

Tribus

Fierbinţeanu-Braticevici

2018

Med Ultrason

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Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.

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Diagnostic imaging and radiation exposure in inflammatory bowel disease

Cited by 50 publications

References 71 publications

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

A validated risk stratification tool for detecting high‐risk small bowel Crohn's disease

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

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