MR/CT enteroclysis requires placement of a postpyloric balloon-tipped tube, most often a nasoduodenal tube, to allow enteric contrast infusion directly into the small bowel. Enteroclysis is performed under fluoroscopy with subsequent patient transfer to MR or CT afterward, which can result in logistical challenges. A study directly comparing MR enteroclysis and MRE in adult patients with suspected or established Crohn disease showed both techniques to be equivalent for detecting terminal ileal inflammation, small bowel fistulae, and strictures [8]. In rare circumstances when enteroclysis may be considered (eg, attempt at uniform small bowel distention to assess for a partial stricture), enteroclysis has been shown to be effective in pediatric patients [9]. However, because enteroclysis is substantially more invasive than enterography, is less well tolerated than enterography, and is without clear added benefit, it is presently infrequently used in children. CTE provides high diagnostic performance for evaluation of Crohn disease activity in pediatric patients, as in adults, with a sensitivity >80% and a specificity >85% compared with endoscopic and histologic reference [11-13]. These studies directly compared CTE and MRE and did not find any significant difference in performance between the two modalities. Furthermore, a meta-analysis based on 290 patients from 6 studies showed sensitivity and specificity in detecting active small bowel Crohn disease was 85.8% and 83.6%, respectively, with an area under the curve (AUC) of 0.898 [14]. CTE imaging features of active Crohn disease inflammation are very similar to those reported Crohn Disease-Child for MRE and include mural (eg, wall thickening and hyperenhancement) and perienteric (eg, engorged vasa recta, fibrofatty proliferation, adenopathy) features of disease [15].
Crohn Disease Child. MR/CT enteroclysis requires placement of a postpyloric balloon-tipped tube, most often a nasoduodenal tube, to allow enteric contrast infusion directly into the small bowel. Enteroclysis is performed under fluoroscopy with subsequent patient transfer to MR or CT afterward, which can result in logistical challenges. A study directly comparing MR enteroclysis and MRE in adult patients with suspected or established Crohn disease showed both techniques to be equivalent for detecting terminal ileal inflammation, small bowel fistulae, and strictures [8]. In rare circumstances when enteroclysis may be considered (eg, attempt at uniform small bowel distention to assess for a partial stricture), enteroclysis has been shown to be effective in pediatric patients [9]. However, because enteroclysis is substantially more invasive than enterography, is less well tolerated than enterography, and is without clear added benefit, it is presently infrequently used in children. CTE provides high diagnostic performance for evaluation of Crohn disease activity in pediatric patients, as in adults, with a sensitivity >80% and a specificity >85% compared with endoscopic and histologic reference [11-13]. These studies directly compared CTE and MRE and did not find any significant difference in performance between the two modalities. Furthermore, a meta-analysis based on 290 patients from 6 studies showed sensitivity and specificity in detecting active small bowel Crohn disease was 85.8% and 83.6%, respectively, with an area under the curve (AUC) of 0.898 [14]. CTE imaging features of active Crohn disease inflammation are very similar to those reported Crohn Disease-Child for MRE and include mural (eg, wall thickening and hyperenhancement) and perienteric (eg, engorged vasa recta, fibrofatty proliferation, adenopathy) features of disease [15].