Ultrasonography of Crohn disease in children

Abstract

US is increasingly performed in Crohn disease (CD) in children as a first line imaging modality. It reduces the use of other more invasive examinations such as endoscopy, CT or contrast enema. We describe bowel ultrasonography technique, normal bowel appearances on US and pathological patterns in CD. We discuss the current role and limitations of bowel US in CD in children including diagnosis, extent of disease, assessment of disease activity, follow-up and detection of complications. The diagnostic accuracy of US is discussed according to the literature and compared to other imaging modalities. US is currently used for screening in children with the suspicion of inflammatory bowel disease (IBD) with a good negative predictive value. In follow-up, US has a role in monitoring medical treatment by evaluating disease activity, extent of disease and for detecting complications.

Prospektiver Vergleich von Power-Dopplersonographie und Ileokoloskopie in der Aktivitätsbewertung bei Patienten mit Morbus Crohn

“…Auch spätere Studien bei Kindern, die an einem Morbus Crohn erkrankten, konnten die guten Ergebnisse der B-Mode-Sonographie bestätigen [Caiulo et al 2003, Alison et al 2007, Strong et al 2007. Diese gute Korrelation zwischen der Dicke der Darmwand und der Entzündungsaktivität, die bei Kindern mit einem Morbus…”

Imaging of the small bowel: Crohn’s disease in paediatric patients

“…US has the distinct advantage of being widely available, inexpensive, non-invasive, radiation-free and relatively easy to perform [7,27] . Over the past few years, improvements in US equipment such as high-frequency transducers (7-12 MHz), combined with oral and intravenous (CE-US) contrast agents [28,29] , have overcome some of the obstacles in bowel US that existed in the past, thus raising a great enthusiasm for its use in IBD children.…”

“…Inflamed bowel can show both mural and extramural pathological changes. Bowel wall thickness is the most important US sign of IBD (Figure 2), with different thickness values used as a threshold for a positive diagnosis in the various reports (from 1.5 mm to 3 mm in the terminal ileum and < 2 mm in the colon) [27,[32][33][34][35] . The other US signs are altered echogenicity, loss of the normally visible stratification (Figure 3), increased Colour-Doppler signal denoting hyperaemia ( Figure 4) and relative decrease or lack in peristalsis signifying some degree of stiffness [31] .…”

The Role of Ultrasound in Intestinal Inflammatory Processes in Children and Adolescents

“…Limitations of this modality are operator dependence and difficulties to assess anatomical region by air-filled bowel or large body habitus [43,44]. Moreover, with the in color Doppler, it observed an increase in flow in the intestinal mucosa and transmural in patients with a wide variety of inflammatory bowel disease, but these ultrasound findings, are not specific to any type of disease, as any inflammatory process produces neovascularization.…”