Fluoroscopy SBFT may also serve as an alternative to MRI and CT to avoid sedation, particularly in younger children. The role of MRE in this scenario include delineation of disease extent, depiction of extraintestinal manifestation of Crohn disease, and detection of penetrating disease complications that may influence treatment decisions (eg, fistulae that may be indicators of biologic therapy or abscess formation that may necessitate antibiotics and/or drainage). Evaluation of small bowel disease is an especially important role for MRE given the limitations of optical endoscopy in small bowel accessibility and visualization, particularly when Crohn disease terminal ileitis causes luminal narrowing [1]. MRI Abdomen and Pelvis MRI of the abdomen and pelvis without oral contrast enterography technique can be considered for Crohn disease patients who may be unable to tolerate sufficient oral contrast, particularly for those with acute abdominal symptoms Radiography Abdomen Visualization of bowel pathology is limited on abdominal radiographs, which restricts utilization. Although cross- sectional techniques have largely supplanted the previous role, radiographs may continue to provide diagnostic information for severely ill children, including those with bowel perforation or bowel obstruction. A recent study of 643 abdominal radiographs (16% were >17 years of age) revealed four cases of pneumoperitoneum, two cases of obstruction, and no cases of toxic megacolon, indicating that these scenarios are uncommon [47]. If present, the information may help modify additional imaging or emergent clinical management, such as additional CT for emergent surgical planning in the setting of a bowel perforation. If radiography is performed for emergent clinical assessment, a left lateral decubitus or upright radiograph should be performed in addition to a supine radiograph for pneumoperitoneum assessment. US Abdomen US abdomen can be used for imaging Crohn disease during acute exacerbation.
Crohn Disease Child. Fluoroscopy SBFT may also serve as an alternative to MRI and CT to avoid sedation, particularly in younger children. The role of MRE in this scenario include delineation of disease extent, depiction of extraintestinal manifestation of Crohn disease, and detection of penetrating disease complications that may influence treatment decisions (eg, fistulae that may be indicators of biologic therapy or abscess formation that may necessitate antibiotics and/or drainage). Evaluation of small bowel disease is an especially important role for MRE given the limitations of optical endoscopy in small bowel accessibility and visualization, particularly when Crohn disease terminal ileitis causes luminal narrowing [1]. MRI Abdomen and Pelvis MRI of the abdomen and pelvis without oral contrast enterography technique can be considered for Crohn disease patients who may be unable to tolerate sufficient oral contrast, particularly for those with acute abdominal symptoms Radiography Abdomen Visualization of bowel pathology is limited on abdominal radiographs, which restricts utilization. Although cross- sectional techniques have largely supplanted the previous role, radiographs may continue to provide diagnostic information for severely ill children, including those with bowel perforation or bowel obstruction. A recent study of 643 abdominal radiographs (16% were >17 years of age) revealed four cases of pneumoperitoneum, two cases of obstruction, and no cases of toxic megacolon, indicating that these scenarios are uncommon [47]. If present, the information may help modify additional imaging or emergent clinical management, such as additional CT for emergent surgical planning in the setting of a bowel perforation. If radiography is performed for emergent clinical assessment, a left lateral decubitus or upright radiograph should be performed in addition to a supine radiograph for pneumoperitoneum assessment. US Abdomen US abdomen can be used for imaging Crohn disease during acute exacerbation.