title: Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children.
abstract: BACKGROUND
  Endoscopy is currently the primary diagnostic technique for inflammatory bowel disease (IBD) in children.
  
  
  OBJECTIVE
  To assess the accuracy of US and dynamic contrast-enhanced MRI for diagnosing inflammatory bowel disease and for distinguishing Crohn disease and ulcerative colitis in comparison to a reference standard.
  
  
  METHODS
  Consecutive children with suspected IBD underwent diagnostic workup including ileocolonoscopy and upper gastrointestinal endoscopy as the reference standard, abdominal US, and MR enterography and colonography at 3 T. The protocol included a dynamic contrast-enhanced 3-D sequence. Sensitivity, specificity and kappa values were calculated for one ultrasonographer and two MRI observers.
  
  
  RESULTS
  We included 28 children (15 boys) with mean age 14 years (range 10-17 years). The diagnosis was IBD in 23 children (72%), including 12 with Crohn disease, 10 with ulcerative colitis and 1 with indeterminate colitis. For the diagnosis of inflammatory bowel disease the sensitivity was 55% for US and 57% (both observers) for MR entero- and colonography, and the specificity was 100% for US and 100% (observer 1) and 75% (observer 2) for MR entero- and colonography. Combined MRI and US had sensitivity and specificity of 70% and 100% (observer 1) and 74% and 80% (observer 2), respectively. With the addition of a dynamic contrast-enhanced MR sequence, the sensitivity increased to 83% and 87%. US and MRI could only distinguish between Crohn disease and ulcerative colitis when terminal ileum lesions were present.
  
  
  CONCLUSIONS
  US and MR entero- and colonography have a high accuracy for diagnosing inflammatory bowel disease in children but cannot be used to distinguish Crohn disease and ulcerative colitis.
authors.affiliation: Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands, m.l.ziech@amc.uva.nl.
authors.forename: Manon L W
authors.initials: ML
authors.lastname: Ziech
authors.forename: Thalia Z
authors.initials: TZ
authors.lastname: Hummel
authors.forename: Anne M J B
authors.initials: AM
authors.lastname: Smets
authors.forename: Rutger A J
authors.initials: RA
authors.lastname: Nievelstein
authors.forename: Cristina
authors.initials: C
authors.lastname: Lavini
authors.forename: Matthan W A
authors.initials: MW
authors.lastname: Caan
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Nederveen
authors.forename: Joris J T H
authors.initials: JJ
authors.lastname: Roelofs
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: Marc A
authors.initials: MA
authors.lastname: Benninga
authors.forename: Angelika
authors.initials: A
authors.lastname: Kindermann
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging* / Q000473:pathology*; D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003424:Crohn Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography