In addition to routine abdominal US without contrast, further discussed below, oral contrast material may be administered by some institutions. Intraluminal oral contrast administration, most commonly with polyethylene glycol, is also termed small intestine contrast ultrasonography (SICUS). SICUS may heighten sensitivity and decrease radiologist interpretation variability [2]. A meta-analysis indicated a pooled sensitivity of 88% and sensitivity of 86% [37]. However, this analysis did not compare SICUS to US without oral contrast administration, and therefore the added benefit was not ascertained. In a prospective pediatric study of 25 patients, the SICUS sensitivity in the terminal ileum was 94%, proximal ileum 80%, and jejunum 92%, with authors concluding SICUS was an effective option for imaging the small bowel [38]. Additional pediatric-focused literature for SICUS is more limited, and direct comparison with and without oral contrast is currently lacking. At present, administration of oral contrast during abdominal US is uncommon in clinical practice. US Abdomen With IV Contrast IV contrast-enhanced US (CEUS) assesses the microbubble enhancement pattern predominately of the bowel wall. Multiple CEUS agents are available, all with strong safety profiles. Following IV administration of these microbubbles, high-frequency sonographic waves cause oscillation of the microbubble core gas resulting in pronounced conspicuity. Quantitative features, such as time to peak enhancement, maximum enhancement, and areas under the enhancement curve, may be determined to supplement analysis. Studies in adult populations found that quantitative analysis facilitated differentiation of inflammatory from fibrostenotic strictures [39] and that both increased maximum peak intensity and wash in slope coefficient was indicative of active disease [40]. A meta-analysis of CEUS based on 8 studies with 428 adult patients indicated a sensitivity of 93%, a specificity of 87%, and an AUC of 0.96 [41].
Crohn Disease Child. In addition to routine abdominal US without contrast, further discussed below, oral contrast material may be administered by some institutions. Intraluminal oral contrast administration, most commonly with polyethylene glycol, is also termed small intestine contrast ultrasonography (SICUS). SICUS may heighten sensitivity and decrease radiologist interpretation variability [2]. A meta-analysis indicated a pooled sensitivity of 88% and sensitivity of 86% [37]. However, this analysis did not compare SICUS to US without oral contrast administration, and therefore the added benefit was not ascertained. In a prospective pediatric study of 25 patients, the SICUS sensitivity in the terminal ileum was 94%, proximal ileum 80%, and jejunum 92%, with authors concluding SICUS was an effective option for imaging the small bowel [38]. Additional pediatric-focused literature for SICUS is more limited, and direct comparison with and without oral contrast is currently lacking. At present, administration of oral contrast during abdominal US is uncommon in clinical practice. US Abdomen With IV Contrast IV contrast-enhanced US (CEUS) assesses the microbubble enhancement pattern predominately of the bowel wall. Multiple CEUS agents are available, all with strong safety profiles. Following IV administration of these microbubbles, high-frequency sonographic waves cause oscillation of the microbubble core gas resulting in pronounced conspicuity. Quantitative features, such as time to peak enhancement, maximum enhancement, and areas under the enhancement curve, may be determined to supplement analysis. Studies in adult populations found that quantitative analysis facilitated differentiation of inflammatory from fibrostenotic strictures [39] and that both increased maximum peak intensity and wash in slope coefficient was indicative of active disease [40]. A meta-analysis of CEUS based on 8 studies with 428 adult patients indicated a sensitivity of 93%, a specificity of 87%, and an AUC of 0.96 [41].