For patients with high clinical concern for Crohn disease and both conventional endoscopy and imaging are unrevealing, video capsule endoscopy may also be considered [4]. Special Imaging Considerations Both MR enterography (MRE) and CT enterography (CTE) require oral contrast material ingestion by the patient. Sufficient bowel distention is necessary to decrease bowel collapse, which can imitate or obscure Crohn disease [7]. Commonly used oral contrast agents for both MRE and CTE include sugar alcohol-based beverages, polyethylene glycol, and low-concentration barium suspensions. Oral contrast administration ultimately depends upon institutional preference. The total volume of oral contrast ingested typically ranges from 900 to 1,500 mL administered over 45 to 60 minutes before the examination, with total volume based on patient weight [7]. Even in the absence of specific concern for perianal fistula, when imaging with MRE/CTE (or nonenterography MR/CT), coverage should include the perineum to facilitate detection of perianal Crohn disease. If discovered, more focused additional imaging of the perineum may be considered (as discussed in Variant 4). Another imaging consideration for perianal Crohn disease is MRI field strength. Although children may be imaged using either 1.5T or 3T MRI, The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Crohn Disease-Child the higher field strength (3T) provides greater signal-to-noise ratio that is advantageous for delineating penetrating Crohn disease anatomic location in relation to anal sphincter complex [6].
Crohn Disease Child. For patients with high clinical concern for Crohn disease and both conventional endoscopy and imaging are unrevealing, video capsule endoscopy may also be considered [4]. Special Imaging Considerations Both MR enterography (MRE) and CT enterography (CTE) require oral contrast material ingestion by the patient. Sufficient bowel distention is necessary to decrease bowel collapse, which can imitate or obscure Crohn disease [7]. Commonly used oral contrast agents for both MRE and CTE include sugar alcohol-based beverages, polyethylene glycol, and low-concentration barium suspensions. Oral contrast administration ultimately depends upon institutional preference. The total volume of oral contrast ingested typically ranges from 900 to 1,500 mL administered over 45 to 60 minutes before the examination, with total volume based on patient weight [7]. Even in the absence of specific concern for perianal fistula, when imaging with MRE/CTE (or nonenterography MR/CT), coverage should include the perineum to facilitate detection of perianal Crohn disease. If discovered, more focused additional imaging of the perineum may be considered (as discussed in Variant 4). Another imaging consideration for perianal Crohn disease is MRI field strength. Although children may be imaged using either 1.5T or 3T MRI, The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Crohn Disease-Child the higher field strength (3T) provides greater signal-to-noise ratio that is advantageous for delineating penetrating Crohn disease anatomic location in relation to anal sphincter complex [6].