In selected monitoring or surveillance scenarios, however, FDG-PET/CT may supplement existing imaging to further help determine the presence of metabolic activity (eg, stricture assessment for surgical planning) [48,49]. A limitation that must be noted is physiological distribution of FDG, including normal uptake in terminal ileum, which may compromise PET imaging of patients with IBD. 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; however, some institutions do perform full-body imaging (from vertex to toes); therefore the area of coverage may be determined according to institutional practices. Fluoroscopy Contrast Enema Colonoscopy is the useful study for evaluation of the colon in patients with suspected or known Crohn disease involving the colon [2]. Fluoroscopy contrast enema is uncommonly used in current practice because of its limited ability to evaluate the small bowel. Fluoroscopy contrast enema, however, may remain an option if selected problem solving is necessary, such as stricture assessment during contrast injection [21]. Fluoroscopy Upper GI Series with Small Bowel Follow-Through Utilizing fluoroscopy SBFT with barium is a historically well-established modality for small bowel evaluation [2]. There is, however, a significant decrease in use of SBFT with current widespread use of cross-sectional imaging modalities including MRI and CT. Although fluoroscopy SBFT allows accurate intraluminal and mucosal assessment, bowel wall thickness among other signs cannot be directly visualized. Additionally, although internal fistulas may be visualized, extraluminal pathologies including abscess formation may only be indirectly inferred. In a study of 87 pediatric patients with IBD utilization histology as criterion standard, 31% of patients had pathology identified on MRI not visualized on SBFT.
Crohn Disease Child. In selected monitoring or surveillance scenarios, however, FDG-PET/CT may supplement existing imaging to further help determine the presence of metabolic activity (eg, stricture assessment for surgical planning) [48,49]. A limitation that must be noted is physiological distribution of FDG, including normal uptake in terminal ileum, which may compromise PET imaging of patients with IBD. 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; however, some institutions do perform full-body imaging (from vertex to toes); therefore the area of coverage may be determined according to institutional practices. Fluoroscopy Contrast Enema Colonoscopy is the useful study for evaluation of the colon in patients with suspected or known Crohn disease involving the colon [2]. Fluoroscopy contrast enema is uncommonly used in current practice because of its limited ability to evaluate the small bowel. Fluoroscopy contrast enema, however, may remain an option if selected problem solving is necessary, such as stricture assessment during contrast injection [21]. Fluoroscopy Upper GI Series with Small Bowel Follow-Through Utilizing fluoroscopy SBFT with barium is a historically well-established modality for small bowel evaluation [2]. There is, however, a significant decrease in use of SBFT with current widespread use of cross-sectional imaging modalities including MRI and CT. Although fluoroscopy SBFT allows accurate intraluminal and mucosal assessment, bowel wall thickness among other signs cannot be directly visualized. Additionally, although internal fistulas may be visualized, extraluminal pathologies including abscess formation may only be indirectly inferred. In a study of 87 pediatric patients with IBD utilization histology as criterion standard, 31% of patients had pathology identified on MRI not visualized on SBFT.