title: Magnetic resonance enterography, small-intestine contrast US, and capsule endoscopy to evaluate the small bowel in pediatric Crohn's disease: a prospective, blinded, comparison study.
abstract: BACKGROUND
  Small-bowel (SB) disease is a severe clinical entity among the phenotypes of Crohn's disease (CD).
  
  
  OBJECTIVE
  To assess sensitivity, specificity, and accuracy of magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and capsule endoscopy (CE) in the diagnosis of pediatric SB-CD.
  
  
  METHODS
  Prospective, blinded, comparison study.
  
  
  METHODS
  Tertiary center for pediatric inflammatory bowel disease.
  
  
  METHODS
  Children with known or suspected CD. Diagnosis of SB obstruction at SICUS or MRE excluded patients from the study.
  
  
  METHODS
  Patients underwent ileocolonoscopy, MRE, SICUS, and CE over a 7-day period. For the imaging evaluation, SB was divided into 3 segments: jejunum, proximal and mid ileum, and terminal ileum.
  
  
  METHODS
  The performance of each method was compared to a consensus reference standard for upper SB and to ileocolonoscopy for the terminal ileum.
  
  
  RESULTS
  Twenty-five patients completed the study. In the jejunum, the sensitivity of SICUS and CE was 92%, which was not significantly higher than MRE (75%); the specificity of CE (61%) was significantly lower than that of MRE (P = .04). In the proximal and mid ileum, MRE and CE did not have significantly higher sensitivity (100%) than SICUS (80%), but CE was less specific (P > .05). At the terminal ileum, SICUS and MRE were slightly more sensitive than CE (94% vs. 81%); however, the latter was more specific.
  
  
  CONCLUSIONS
  Use of the consensus reference standard for upper SB. Small number of patients.
  
  
  CONCLUSIONS
  SICUS, MRE, and CE are all effective options for imaging SB. An integrated use of different tools should be suggested to achieve a complete assessment of the SB in children with suspected or confirmed CD.
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Aloi
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Nardo
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Giusy
authors.initials: G
authors.lastname: Romano
authors.affiliation: Radiology DEA, Sapienza University of Rome, Rome, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Casciani
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Fortunata
authors.initials: F
authors.lastname: Civitelli
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Oliva
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Viola
authors.affiliation: Radiologic, Oncologic and Anatomophatological Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Maccioni
authors.affiliation: Radiology DEA, Sapienza University of Rome, Rome, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Gualdi
authors.affiliation: Pediatric Gastroenterology and Liver Unit, Sapienza University of Rome, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003424:Crohn Disease / Q000175:diagnosis*; D019160:Endosonography; D005260:Female; D006801:Humans; D007421:Intestine, Small; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016037:Single-Blind Method
chemical_list: D003287:Contrast Media