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01-07-2017 | Original Article

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

Authors: Timothy L. Tsai, Megan B. Marine, Matthew R. Wanner, Matthew L. Cooper, Steven J. Steiner, Fangqian Ouyang, S. Gregory Jennings, Boaz Karmazyn

Published in: Pediatric Radiology | Issue 8/2017

Abstract

Background

There is growing literature on the use of ultrasound (US) for evaluation of Crohn disease in adults, but few studies have been conducted on children. Several studies demonstrated high accuracy of US in the diagnosis of Crohn disease. Using US as the primary screening imaging modality for Crohn disease can reduce health care costs, the need for sedation and ionizing radiation exposure.

Objective

The aim of our study is to determine if US can be used for screening evaluation of pediatric Crohn disease.

Materials and methods

A prospective cohort study of pediatric patients undergoing MR enterography (MRE) for suspected or known history of Crohn disease was performed, with gray-scale and Doppler US of the terminal ileum done immediately before or after MRE. US images were interpreted by two radiologists (Reader 1 and Reader 2) not involved in image acquisition, in blinded and randomized fashion. US findings of Crohn disease including bowel wall thickening, wall stratification, increased vascularity on Doppler, lymphadenopathy, fat infiltration and extraintestinal complications were evaluated. MRE findings of terminal ileitis were considered the reference standard. Demographic data, body mass index (BMI), symptoms, and laboratory, endoscopic and histopathological data were obtained from electronic medical records.

Results

Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6< kappa <0.8).

Conclusion

In screening for Crohn disease in children, US has limited sensitivity for detecting terminal ileitis.

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Title: Can ultrasound be used as the primary imaging in children with suspected Crohn disease?
Authors: Timothy L. Tsai
Megan B. Marine
Matthew R. Wanner
Matthew L. Cooper
Steven J. Steiner
Fangqian Ouyang
S. Gregory Jennings
Boaz Karmazyn
Publication date: 01-07-2017
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 8/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-017-3849-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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