Small-intestine contrast ultrasonography, magnetic resonance enterography and capsule endoscopy were all found to be effective options for imaging the small bowel to diagnose pediatric inflammatory bowel disease, according to recent study data.
Aiming to evaluate the performance of these three methods in assessing pediatric Crohn’s disease and detecting active lesions in specific segments of the small bowel, researchers performed a prospective, masked comparison study involving 25 children with known or suspected CD. All patients underwent ileocolonoscopy, magnetic resonance enterography (MRE; 1.5-Tesla whole-body MRI, Siemens Medical Solutions), small-intestine contrast ultrasonography (SICUS; Aplio XG, Toshiba Medical Systems) and capsule endoscopy (CE; PillCam, Given Imaging) during a 1-week period from April 2012 to April 2013. They compared the results of each method with a consensus reference standard for the upper small bowel and with ileocolonoscopy for the terminal ilium.
In the jejunum, SICUS and CE both had 92% (95% CI, 61-100) sensitivity, which was higher than MRE (75%; 95% CI, 43-94) but not significantly, whereas the specificity of MRE (94%; 95% CI, 73-100) was significantly higher compared with CE (61%; 95% CI, 36-83). In the proximal and mid-ileum, MRE and CE both had 100% sensitivity (95% CI, 56-100 with MRE; 95% CI, 48-100 with CE) vs. 80% (95% CI, 43-99) with SICUS, but CE had 74% specificity (95% CI, 49-90) compared with 92% (95% CI, 73-99) for both SICUS and MRE. At the terminal ileum, SICUS and MRE both had 94% sensitivity (95% CI, 64-100 with SICUS; 95% CI, 71-100 with MRE) vs. 81% (95% CI, 54-96) with CE, whereas CE had 90% (95% CI, 55-100) specificity vs. 80% (95% CI, 51-96) with MRE and 79% (95% CI, 49-95) with SICUS.
“Our study supports the use of radiation-free and well-tolerated imaging modalities as a means of first-line investigation in children with suspected or already diagnosed CD,” the researchers concluded. “The combination of SICUS and [C-reactive protein], given its high sensitivity, specificity, low-cost, and non-invasiveness, could be suggested as a first-line diagnostic approach in suspected [small-bowel] CD. MRE and CE can be subsequently used in patients with inconclusive workups, based on the local expertise and availability.” – by Adam Leitenberger
Disclosure: The researchers report no relevant financial disclosures.