A study comparing the performance of different CTE and MRE imaging features compared with histologic reference showed that mural features of disease (wall thickening and hyperenhancement) performed better than perienteric features in evaluating activity and may be more reliable features in cases where some but not all features of activity are present [16]. FDG-PET/CT Skull Base to Mid-Thigh At the present time, there is a paucity of larger clinical studies published for fluorine-18-2-fluoro-2-deoxy-D- glucose (FDG)-PET/CT in the setting of Crohn disease, particularly in children, and an absence of literature to support this as an initial imaging modality prior to diagnosis. Adding metabolic information from FDG-PET to anatomic CT imaging shows the potential to further diagnostic accuracy in children. A meta-analysis of 7 studies with a total of 219 patients (3 studies with 93 patients were pediatric focused) on a per segment basis showed sensitivity was 85%, specificity 87%, and area under the receiver operating characteristic curve was 0.93. PET/CT may be particularly helpful to assess the level of active inflammation from fibrosis [18]. One pediatric study with 23 patients showed a sensitivity and specificity for the terminal ileum of 89% and 75%, respectively [19]. A limitation that must be noted is physiological distribution of FDG, including normal uptake in the terminal ileum, which may compromise PET imaging of patients with IBD. Although potentially promising, additional development for PET/CT in children is necessary. If performing FDG-PET/CT for the evaluation of Crohn disease, the area of coverage from skull base to mid-thigh may be sufficient for bowel evaluation, although some institutions do perform full-body imaging (from vertex to toes); therefore area of coverage may be determined according to institutional practices.
Crohn Disease Child. A study comparing the performance of different CTE and MRE imaging features compared with histologic reference showed that mural features of disease (wall thickening and hyperenhancement) performed better than perienteric features in evaluating activity and may be more reliable features in cases where some but not all features of activity are present [16]. FDG-PET/CT Skull Base to Mid-Thigh At the present time, there is a paucity of larger clinical studies published for fluorine-18-2-fluoro-2-deoxy-D- glucose (FDG)-PET/CT in the setting of Crohn disease, particularly in children, and an absence of literature to support this as an initial imaging modality prior to diagnosis. Adding metabolic information from FDG-PET to anatomic CT imaging shows the potential to further diagnostic accuracy in children. A meta-analysis of 7 studies with a total of 219 patients (3 studies with 93 patients were pediatric focused) on a per segment basis showed sensitivity was 85%, specificity 87%, and area under the receiver operating characteristic curve was 0.93. PET/CT may be particularly helpful to assess the level of active inflammation from fibrosis [18]. One pediatric study with 23 patients showed a sensitivity and specificity for the terminal ileum of 89% and 75%, respectively [19]. A limitation that must be noted is physiological distribution of FDG, including normal uptake in the terminal ileum, which may compromise PET imaging of patients with IBD. Although potentially promising, additional development for PET/CT in children is necessary. If performing FDG-PET/CT for the evaluation of Crohn disease, the area of coverage from skull base to mid-thigh may be sufficient for bowel evaluation, although some institutions do perform full-body imaging (from vertex to toes); therefore area of coverage may be determined according to institutional practices.