Inflammatory bowel disease—the role of cross-sectional imaging techniques in the investigation of the small bowel

Abstract

Background: The diagnosis of inflammatory bowel disease (IBD) in children and adolescents is based on the integration of clinical, biological, endoscopic, histological and radiological data. Methods: The most important part of the diagnosis is the histology, which is acquired by endoscopy. Imaging of the small bowel has changed in recent years, but the imaging goals are primarily to determine the extent of small bowel involvement, assess complications and define candidates for surgery. Imaging techniques are divided into conventional and cross-sectional ones. Results: The spectrum of imaging findings of cross-sectional techniques is discussed, emphasising the advantages and limitations of each technique, acknowledging the specificities of the paediatric population. Cross-sectional techniques have advanced the ability to diagnose and monitor inflammatory disease of the small bowel. Conclusion: MR enterography is the technique of choice in children with known IBD, for the investigation of the small bowel and the whole GI tract. US should be the first choice examination in children with suspected IBD, while CT should be reserved for cases in which MRI is contraindicated or in acute emergency situations when US is inadequate.Teaching Points• Cross-sectional imaging of the small bowel is essential in paediatric IBD.• Endoscopy is unable to assess extramural disease and examine the entire small bowel.• US should be the first choice examination in children with suspected IBD.• MR enterography is the technique of choice in children with known IBD.• There are still controversies regarding the prediction of disease activity or fibrosis.

Usefulness of intestinal real‐time virtual sonography in patients with inflammatory bowel disease

“…However, MRI is expensive and is not easily accessible for all IBD patients. US is a noninvasive, radiation‐free, and inexpensive modality compared with CT, MRI, and endoscopy . Intestinal US has been reported useful for diagnosing of IBD and assessment of IBD disease activity .…”

“…US is a noninvasive, radiation-free, and inexpensive modality compared with CT, MRI, and endoscopy. 24,25 Intestinal US has been reported useful for diagnosing of IBD and assessment of IBD disease activity. 13,26 A recent meta-analysis showed that US has a high diagnostic accuracy for detecting CD.…”

Assessment of Disease Activity in Small Bowel Crohn’s Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using MRIA and Modified MRIA Score

“…To monitor disease activity and to guide appropriate treatment, CD patients require multiple imaging examinations repeatedly [ 8 ]. Cross-sectional techniques have advanced the ability to diagnose, classify, and monitor CD [ 9 ]; the desirable imaging modality would be one that is reproducible, free of ionizing radiation, and well tolerated. MR-E is a noninvasive technique not relying on ionizing radiation, showing high values of sensitivity and specificity in CD assessment [ 10 ] and nowadays the standard protocol is based on morphologic unenhanced images and on dynamic fast 3D spoiled gradient echo T1 fat-suppressed postcontrast sequence that evaluates the pattern of bowel wall enhancement [ 11 ].…”

Nanoparticle‐based imaging of inflammatory bowel disease

“…These agents are used for the delineation of extra‐enteric structures, fistulae, abscesses, lymphadenopathy, wall thickening, luminal narrowing, and other abnormalities. CTE is by far the most widely used of the modalities for evaluation of IBD and numerous references may be found in the literature with respect to the use of CTE for IBD . CTE has, however, lower spatial resolution when compared to conventional enterography, as motion artifacts (caused by peristaltic motion) may greatly reduce image quality.…”