title: Optimal assessment of paediatric IBD with MRI and barium follow-through.
abstract: OBJECTIVE
  The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population.
  
  
  METHODS
  All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review.
  
  
  RESULTS
  Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n=59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively.
  
  
  CONCLUSIONS
  This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.
authors.affiliation: Department of Paediatric Gastroenterology, Barts and The London Children's Hospital, London, United Kingdom. e.m.giles@qmul.ac.uk
authors.forename: Edward
authors.initials: E
authors.lastname: Giles
authors.forename: Ozan
authors.initials: O
authors.lastname: Hanci
authors.forename: Alison
authors.initials: A
authors.lastname: McLean
authors.forename: Niall
authors.initials: N
authors.lastname: Power
authors.forename: Angela
authors.initials: A
authors.lastname: Cole
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Croft
authors.forename: Kirsteen
authors.initials: K
authors.lastname: McDonald
authors.forename: Sam
authors.initials: S
authors.lastname: Chippington
authors.forename: Sandhia
authors.initials: S
authors.lastname: Naik
mesh_terms: D000293:Adolescent; D001464:Barium; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D003952:Diagnostic Imaging / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011859:Radiography; D006113:United Kingdom
chemical_list: D003287:Contrast Media; D001464:Barium