Pediatric inflammatory bowel disease: imaging issues with targeted solutions.
To date, there have been many advances in inflammatory bowel disease (IBD) imaging in every cross-sectional imaging modality, particularly in children. The main emphasis in pediatric IBD imaging is on robust and reproducible measures of small bowel Crohn's disease inflammation, accurate diagnosis of IBD-related complications, and minimizing radiation burden to the patient, as repeat imaging is necessary over the course of their disease. In this article, we discuss the current state-of-the-art imaging techniques, in addition to routine fluoroscopy, including MR and CT enterography and bowel ultrasound. We also present the emerging use of new methods to characterize disease severity and distinguish active inflammation from fibrosis such as diffusion-weighted imaging, bowel elastography, and contrast-enhanced ultrasound. The diagnostic performance of particular examinations, their strengths and weaknesses, and role in IBD management will be discussed. Although these advanced imaging techniques applied to children are similar to those performed in adults, special considerations related to their application in pediatric patients will also be reviewed.
Department of Radiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA, anupindi@email.chop.edu.
Sudha A
SA
Anupindi
Daniel J
DJ
Podberesky
Alexander J
AJ
Towbin
Jesse
J
Courtier
Michael S
MS
Gee
Kassa
K
Darge
Jonathan R
JR
Dillman
D000293:Adolescent; D002648:Child; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007089:Image Enhancement; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis*; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D003287:Contrast Media