A different meta-analysis of CEUS of 8 articles with a total of 332 adult patients indicated a pooled sensitivity of 94% and specificity of 79% [42]. Also, there is a paucity of literature that reveals added benefit beyond US without IV contrast. One adult study, however, did show that quantitative CEUS parameters integrated with grayscale US with color Doppler imaging reduced indeterminate results [43]. Currently, there is a lack of studies using CEUS in children. This fact, combined with a paucity of literature supporting added benefit of CEUS beyond routine US, limits CEUS appropriateness at the present time as the initial imaging study. However, future studies are anticipated given the CEUS safety profile and adult literature. CEUS will likely be an area of future development for children with Crohn disease. Another avenue of potential future development that may supplement CEUS is determining the role to US shear wave elastography in pediatric patients, because literature is starting to emerge in adults [44]. WBC Scan Whole Body Tc-99m-hexamethyl propylene amine oxime-labeled white blood cell (Tc-99m HMPAO WBC) scan studies show sensitivities from 75% to 94% and specificities from 92% to 99% for intestinal inflammation in children [45]. More recently, Chroustova et al [46] found a sensitivity of 89% and specificity of 91% in 85 children. Although the Crohn Disease-Child diagnostic parameters of a WBC scan whole body are useful for both diagnosis and disease activity assessment, significant practical limitations exist. One disadvantage is the decreased ability to detect and evaluate alternative diagnoses. Other significant disadvantages are the technical aspects, including the volume of blood required for labeling, longer acquisition times, and limited usage for initial diagnosis. Variant 2: Child. Known Crohn disease, suspected acute exacerbation. Initial Imaging.
Crohn Disease Child. A different meta-analysis of CEUS of 8 articles with a total of 332 adult patients indicated a pooled sensitivity of 94% and specificity of 79% [42]. Also, there is a paucity of literature that reveals added benefit beyond US without IV contrast. One adult study, however, did show that quantitative CEUS parameters integrated with grayscale US with color Doppler imaging reduced indeterminate results [43]. Currently, there is a lack of studies using CEUS in children. This fact, combined with a paucity of literature supporting added benefit of CEUS beyond routine US, limits CEUS appropriateness at the present time as the initial imaging study. However, future studies are anticipated given the CEUS safety profile and adult literature. CEUS will likely be an area of future development for children with Crohn disease. Another avenue of potential future development that may supplement CEUS is determining the role to US shear wave elastography in pediatric patients, because literature is starting to emerge in adults [44]. WBC Scan Whole Body Tc-99m-hexamethyl propylene amine oxime-labeled white blood cell (Tc-99m HMPAO WBC) scan studies show sensitivities from 75% to 94% and specificities from 92% to 99% for intestinal inflammation in children [45]. More recently, Chroustova et al [46] found a sensitivity of 89% and specificity of 91% in 85 children. Although the Crohn Disease-Child diagnostic parameters of a WBC scan whole body are useful for both diagnosis and disease activity assessment, significant practical limitations exist. One disadvantage is the decreased ability to detect and evaluate alternative diagnoses. Other significant disadvantages are the technical aspects, including the volume of blood required for labeling, longer acquisition times, and limited usage for initial diagnosis. Variant 2: Child. Known Crohn disease, suspected acute exacerbation. Initial Imaging.