Particularities of Crohn’s disease in pediatric patients: current status and perspectives regarding imaging modalities

Abstract

A consensus on the best imaging modality evaluating inflammatory bowel disease in the pediatric population is lacking and it is often unclear which modality to choose in specific clinical circumstances. Children with inflammatory bowel disease are exposed to ionizing radiation from multiple imaging studies performed at initial diagnosis, throughout treatment and during the follow-up period. This paper discusses the value of different imaging techniques in pediatric patients with inflammatory bowel disease and gives a review of the literature. In addition, particular features of inflammatory bowel disease in children including the predilection of affected segments in the gastrointestinal tract are highlighted. Based on current literature knowledge, we encourage an integrative approach to the interpretation of clinical and imaging data for diagnosis and follow-up in daily clinical settings.

Keywords:

• children
• computed tomography
• Crohn’s disease
• guidelines
• inflammatory bowel disease
• MRI
• pediatric
• ulcerative colitis
• ultrasonography

Financial & competing interests disclosure

Xin-Wu Cui was supported by Bad Mergentheim Leberzentrum e.V. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Inflammatory bowel disease, including Crohn’s disease, ulcerative colitis and indeterminate colitis, is one of the most common gastrointestinal diseases affecting pediatric patients. Its diagnosis and classification is based on endoscopic and imaging features, finally being based on histological findings.

• In pediatric patients, due to particular features regarding symptoms at presentation, disease location and imaging characteristics, the diagnosis can be challenging.

• Choosing the appropriate imaging modality for children with suspected or diagnosed inflammatory bowel disease depends on age-related particularities, including the necessity of sedation for some investigations, and also needs careful consideration of the cumulative radiation dose from the repeated examination along a life-time follow-up.

• Ultrasound allows a good visualization of bowel wall morphology, being proved as a sensitive and specific modality to assess disease activity. Recent advances including the use of oral or intravenous contrast agents are particularly helpful in this regard.

• According to the European Society for Paediatric Gastroenterology Hepatology and Nutrition, US in skilled hands is an excellent modality to examine the thickened small bowel loops in Crohn’s disease pediatric patients, to identify abscesses or ascitic collections. It is also recommended by the second European evidence-based consensus on diagnosis and management of Crohn’s disease in pediatric age group and by the European Cancer Organization–European Society of Gastrointestinal and Abdominal Radiology imaging guidelines, both for the initial assessment at presentation, and for follow-up to search for possible related complications.

• Recent data have shown that bowel ultrasonography can also be used for initial diagnosis and follow-up in pediatric patients with ulcerative colitis.

Notes