In a meta-analysis, based on only three studies with 86 patients, it demonstrated an accuracy of only 44% [55]. A prospective pediatric study with subjects undergoing US before and after initiation of medical therapy with 29 patients and 231 US examinations was performed. US agreement was only moderate for involved length, bowel wall Doppler signal, and stricture; however, it was more substantial for maximum bowel wall thickness, penetrating disease, and abscess [56]. These authors did question US accuracy and reproducibility for assessment of medical therapy. US Abdomen With IV Contrast CEUS assesses microbubble enhancement pattern predominately of the bowel wall. Multiple CEUS agents are available, all with strong safety profiles. Following IV administration of these microbubbles, high-frequency sonographic waves cause oscillation of the microbubble core gas resulting in pronounced conspicuity. Quantitative features, such as time to peak enhancement, maximum enhancement, and areas under the enhancement curve, may be determined to supplement analysis. Studies in adult populations found that quantitative analysis facilitated differentiation of inflammatory from fibrostenotic strictures [39] and that both increased maximum peak intensity and wash in slope coefficient was indicative of active disease [40]. A meta-analysis of CEUS based on 8 studies with 428 adult patients indicated a sensitivity of 93%, a specificity of 87%, and an AUC of 0.96 [41]. A different meta-analysis of CEUS of 8 articles with a total of 332 adult patients indicated a pooled sensitivity of 94% and a specificity of 79% [42]. Also, there is a paucity of literature that reveals added benefit beyond US without IV contrast. One adult study, however, did show that quantitative CEUS parameters integrated with grayscale US with color Doppler imaging reduced indeterminate results [43]. Currently, there is a paucity of studies using CEUS in children.
Crohn Disease Child. In a meta-analysis, based on only three studies with 86 patients, it demonstrated an accuracy of only 44% [55]. A prospective pediatric study with subjects undergoing US before and after initiation of medical therapy with 29 patients and 231 US examinations was performed. US agreement was only moderate for involved length, bowel wall Doppler signal, and stricture; however, it was more substantial for maximum bowel wall thickness, penetrating disease, and abscess [56]. These authors did question US accuracy and reproducibility for assessment of medical therapy. US Abdomen With IV Contrast CEUS assesses microbubble enhancement pattern predominately of the bowel wall. Multiple CEUS agents are available, all with strong safety profiles. Following IV administration of these microbubbles, high-frequency sonographic waves cause oscillation of the microbubble core gas resulting in pronounced conspicuity. Quantitative features, such as time to peak enhancement, maximum enhancement, and areas under the enhancement curve, may be determined to supplement analysis. Studies in adult populations found that quantitative analysis facilitated differentiation of inflammatory from fibrostenotic strictures [39] and that both increased maximum peak intensity and wash in slope coefficient was indicative of active disease [40]. A meta-analysis of CEUS based on 8 studies with 428 adult patients indicated a sensitivity of 93%, a specificity of 87%, and an AUC of 0.96 [41]. A different meta-analysis of CEUS of 8 articles with a total of 332 adult patients indicated a pooled sensitivity of 94% and a specificity of 79% [42]. Also, there is a paucity of literature that reveals added benefit beyond US without IV contrast. One adult study, however, did show that quantitative CEUS parameters integrated with grayscale US with color Doppler imaging reduced indeterminate results [43]. Currently, there is a paucity of studies using CEUS in children.