Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

Abstract

Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.

Abdominal ultrasonography of the pediatric gastrointestinal tract

“…Ultrasound has been found to have a high correlation with MR imaging findings in pediatric small bowel Crohn disease [77] . Ultrasound demonstrates mural thickening with loss of wall stratification, hyperemia, and decreased peristalsis.…”

“…Contrast enhanced ultrasound using IV administration of microbubble contrast shows promising results; the pattern of mural enhancement may aid in assessment of disease activity and/or response to therapy [80] . Ultrasound elastography, a technique that measures tissue stiffness, may help to differentiate inflammation from fibrosis in Crohn disease [77] . Ultrasound also has a role in evaluating ulcerative colitis.…”

Can ultrasound be used as the primary imaging in children with suspected Crohn disease?

“…US does not use ionizing radiation and is also inexpensive compared to CT enterography and MRE. Bowel US has been a routine part of IBD evaluation in Europe for more than 20 years [3,4]; however, this modality is only now becoming established in the evaluation of patients in North America [4][5][6][7][8][9][10]. While the efficacy of US to evaluate Crohn disease in adults has been validated by many studies in Europe, to our knowledge there are few studies in children in either Europe or North America [5][6][7][8].…”

“…Bowel US has been a routine part of IBD evaluation in Europe for more than 20 years [3,4]; however, this modality is only now becoming established in the evaluation of patients in North America [4][5][6][7][8][9][10]. While the efficacy of US to evaluate Crohn disease in adults has been validated by many studies in Europe, to our knowledge there are few studies in children in either Europe or North America [5][6][7][8]. Despite this limitation, several authors already suggest using US as the first line of imaging for screening and follow-up of Crohn disease in children [3][4][5][6][7][8][9][10].…”

“…While the efficacy of US to evaluate Crohn disease in adults has been validated by many studies in Europe, to our knowledge there are few studies in children in either Europe or North America [5][6][7][8]. Despite this limitation, several authors already suggest using US as the first line of imaging for screening and follow-up of Crohn disease in children [3][4][5][6][7][8][9][10].…”