Another study of 20 pediatric Crohn disease patients with symptomatic small bowel strictures and preoperative MRE [53] showed a significant histological correlation between fibrosis and inflammation (rho = 0.55) within strictures, as well as a significant association between small bowel dilation >3 cm on MRE and stricture fibrosis (odds ratio = 43). A study of 25 pediatric Crohn disease patients who underwent bowel stricture resection with preoperative MRE showed that texture analysis of the bowel wall signal intensities for detecting stricture fibrosis had a goodness-of- fit AUC value of 0.995 [54]. Radiography Abdomen Visualization of bowel pathology is limited on abdominal radiographs, which restricts use for disease surveillance or monitoring therapy. Crohn Disease-Child US Abdomen US abdomen can be used for imaging Crohn disease during therapy monitoring. US may be a particularly suitable alternative for younger children who would otherwise require sedation for MRE or CTE examinations [21]. Sonographic technique requires a systematic assessment of the entire bowel including terminal ileum, colon, and more proximal small bowel. All four quadrants of the abdomen should be evaluated in both the transverse and longitudinal planes [32]. Color Doppler US is also performed to facilitate mural hyperemia assessment. Sonographic features include abnormal bowel wall thickening (>3 mm in children), alteration of bowel wall signature, adjacent fatty proliferation, hyperemia, and engorgement of the vasa recta [32]. Patient features may adversely affect US including elevated body mass index as well as bowel gas resulting in shadowing. In the setting of pediatric Crohn disease though, obesity is less likely given that many patients have diminished nutrition [32]. The detection of alternative diagnoses is also decreased compared with CT or MRI. Literature supporting the use of US for grading disease activity is only partially developed.
Crohn Disease Child. Another study of 20 pediatric Crohn disease patients with symptomatic small bowel strictures and preoperative MRE [53] showed a significant histological correlation between fibrosis and inflammation (rho = 0.55) within strictures, as well as a significant association between small bowel dilation >3 cm on MRE and stricture fibrosis (odds ratio = 43). A study of 25 pediatric Crohn disease patients who underwent bowel stricture resection with preoperative MRE showed that texture analysis of the bowel wall signal intensities for detecting stricture fibrosis had a goodness-of- fit AUC value of 0.995 [54]. Radiography Abdomen Visualization of bowel pathology is limited on abdominal radiographs, which restricts use for disease surveillance or monitoring therapy. Crohn Disease-Child US Abdomen US abdomen can be used for imaging Crohn disease during therapy monitoring. US may be a particularly suitable alternative for younger children who would otherwise require sedation for MRE or CTE examinations [21]. Sonographic technique requires a systematic assessment of the entire bowel including terminal ileum, colon, and more proximal small bowel. All four quadrants of the abdomen should be evaluated in both the transverse and longitudinal planes [32]. Color Doppler US is also performed to facilitate mural hyperemia assessment. Sonographic features include abnormal bowel wall thickening (>3 mm in children), alteration of bowel wall signature, adjacent fatty proliferation, hyperemia, and engorgement of the vasa recta [32]. Patient features may adversely affect US including elevated body mass index as well as bowel gas resulting in shadowing. In the setting of pediatric Crohn disease though, obesity is less likely given that many patients have diminished nutrition [32]. The detection of alternative diagnoses is also decreased compared with CT or MRI. Literature supporting the use of US for grading disease activity is only partially developed.