title: Positron emission tomography in the investigation of pediatric inflammatory bowel disease.
abstract: BACKGROUND
  Endoscopic and radiologic studies are frequently required in inflammatory bowel disease (IBD) to determine disease activity, extent of disease, and delineating disease type. Positron emission tomography (PET) using fluorine-18-fluoro-deoxyglucose to identify metabolically active tissues may offer a simple noninvasive alternative to conventional studies in identification and localization of active intestinal inflammation in children with IBD. The aim of this study was to assess the value of PET in identifying active intestinal inflammation compared with conventional endoscopic and radiologic studies, including small bowel follow-through and colonoscopy.
  
  
  METHODS
  Sixty-five children were enrolled in the study. This included 55 children (mean age, 13.3 yr; range, 7-18 yr; 20 girls) with newly diagnosed IBD (37) or symptoms suggestive of recurrent disease (18) and 10 children with recurrent abdominal pain (mean age, 12.7 yr; range, 8-15 yr; 7 girls) who were studied with PET, and the results were compared with small bowel follow-through with pneumocolon and/or colonoscopy. Thirty-eight patients had Crohn's disease (17 ileal, 12 ileocolic, 5 pancolonic, 3 left-sided disease, 1 right-sided disease), and 17 had ulcerative colitis (15 pan-colitis, 2 left-sided colitis). Mean time interval between PET and other studies was 30 +/- 17.6 days.
  
  
  RESULTS
  PET correctly identified active inflammatory disease in 80% of children with IBD (81.5% with Crohn's disease; 76.4% with ulcerative colitis) and correctly showed no evidence of inflammation in children with recurrent abdominal pain. Gluorine-18-fluoro-deoxyglucose accumulated at sites that corresponded with active disease at colonoscopy in 83.8% of patients and with small bowel follow-through with pneumocolon 75.0% of the time.
  
  
  CONCLUSIONS
  This study suggests that PET offers a noninvasive tool for identifying and localizing active intestinal inflammation in children with IBD. PET may not be able to replace conventional studies; however, it may be useful when conventional studies cannot be performed or fail to be completed.
authors.affiliation: Division of Gastroenterology, British Columbia Children's Hospital, Vancouver, Canada.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Lemberg
authors.forename: Robert M
authors.initials: RM
authors.lastname: Issenman
authors.forename: Ruth
authors.initials: R
authors.lastname: Cawdron
authors.forename: Tim
authors.initials: T
authors.lastname: Green
authors.forename: John
authors.initials: J
authors.lastname: Mernagh
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Skehan
authors.forename: Claude
authors.initials: C
authors.lastname: Nahmias
authors.forename: Kevan
authors.initials: K
authors.lastname: Jacobson
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging* / Q000473:pathology; D003113:Colonoscopy / Q000379:methods; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index