Pediatric Radiology

, Volume 37, Issue 11, pp 1071–1082 | Cite as

Ultrasonography of Crohn disease in children

  • Marianne Alison
  • Ahmed Kheniche
  • Robin Azoulay
  • Sandrine Roche
  • Guy Sebag
  • Nadia Belarbi
Minisymposium

Abstract

US is increasingly performed in Crohn disease (CD) in children as a first line imaging modality. It reduces the use of other more invasive examinations such as endoscopy, CT or contrast enema. We describe bowel ultrasonography technique, normal bowel appearances on US and pathological patterns in CD. We discuss the current role and limitations of bowel US in CD in children including diagnosis, extent of disease, assessment of disease activity, follow-up and detection of complications. The diagnostic accuracy of US is discussed according to the literature and compared to other imaging modalities. US is currently used for screening in children with the suspicion of inflammatory bowel disease (IBD) with a good negative predictive value. In follow-up, US has a role in monitoring medical treatment by evaluating disease activity, extent of disease and for detecting complications.

Keywords

Crohn disease Ultrasonography Children 

References

  1. 1.
    Kim SC, Ferry GD (2004) Inflammatory bowel diseases in paediatric and adolescent patients: clinical, therapeutic, and psychosocial considerations. Gastroenterology 126:1550–1560PubMedCrossRefGoogle Scholar
  2. 2.
    Schmidt T, Hohl C, Haage P et al (2005) Phase-inversion tissue harmonic imaging compared to fundamental B-mode ultrasound in the evaluation of the pathology of large and small bowel. Eur Radiol 15:2021–2030PubMedCrossRefGoogle Scholar
  3. 3.
    Tarjan Z, Toth G, Gyorke T et al (2000) Ultrasound in Crohn’s disease of the small bowel. Eur J Radiol 35:176–182PubMedCrossRefGoogle Scholar
  4. 4.
    Kimmey MB, Martin RW, Haggitt RC et al (1989) Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 96:433–441PubMedGoogle Scholar
  5. 5.
    Valette PJ, Rioux M, Pilleul F et al (2001) Ultrasonography of chronic inflammatory bowel diseases. Eur Radiol 11:1859–1866PubMedCrossRefGoogle Scholar
  6. 6.
    Faure C, Belarbi N, Mougenot JF et al (1997) Ultrasonographic assessment of inflammatory bowel disease in children: comparison with ileocolonoscopy. J Pediatr 130:147–151PubMedCrossRefGoogle Scholar
  7. 7.
    Haber HP, Busch A, Ziebach R et al (2002) Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides. J Ultrasound Med 21:375–382PubMedGoogle Scholar
  8. 8.
    Auvin S, Molinie F, Gower Rousseau C et al (2005) Incidence, clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population based study in Northern France (1988–199). J Pediatr Gastroenterol Nutr 41: 49–55Google Scholar
  9. 9.
    Dinkel E, Dittrich M, Peters H et al (1986) Real-time ultrasound in Crohn’s disease: characteristic features and clinical implications. Pediatr Radiol 16:8–12PubMedCrossRefGoogle Scholar
  10. 10.
    Fraquelli M, Colli A, Casazza G et al (2005) Role of US in detection of Crohn disease: meta-analysis. Radiology 236:95–101PubMedCrossRefGoogle Scholar
  11. 11.
    Canani RB, de Horatio LT, Terrin G et al (2006) Combined use of noninvasive tests is useful in the initial diagnostic approach to a child with suspected inflammatory bowel disease. J Pediatr Gastroenterol Nutr 42:9–15PubMedCrossRefGoogle Scholar
  12. 12.
    Borthne AS, Abdelnoor M, Rugtveit J et al (2006) Bowel magnetic resonance imaging of pediatric patients with oral mannitol MRI compared to endoscopy and intestinal ultrasound. Eur Radiol 16:207–214PubMedCrossRefGoogle Scholar
  13. 13.
    Bremner AR, Pridgeon J, Fairhurst J et al (2004) Ultrasound scanning may reduce the need for barium radiology in the assessment of small-bowel Crohn’s disease. Acta Paediatr 93:479–481PubMedCrossRefGoogle Scholar
  14. 14.
    Ripolles T, Martinez MJ, Morote V et al (2006) Appendiceal involvement in Crohn’s disease: gray-scale sonography and color Doppler flow features. AJR 186:1071–1078PubMedCrossRefGoogle Scholar
  15. 15.
    Calabrese E, La Seta F, Buccellato A et al (2005) Crohn’s disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema. Inflamm Bowel Dis 11:139–145PubMedCrossRefGoogle Scholar
  16. 16.
    Pallotta N, Tomei E, Viscido A et al (2005) Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease. Inflamm Bowel Dis 11:146–153PubMedCrossRefGoogle Scholar
  17. 17.
    Parente F, Greco S, Molteni M et al (2004) Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy. Gut 53:1652–1657PubMedCrossRefGoogle Scholar
  18. 18.
    Parente F, Greco S, Molteni M et al (2003) Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel. Aliment Pharmacol Ther 18:1009–1016PubMedCrossRefGoogle Scholar
  19. 19.
    Potthast S, Rieber A, Von Tirpitz C et al (2002) Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison. Eur Radiol 12:1416–1422PubMedCrossRefGoogle Scholar
  20. 20.
    Haber HP, Busch A, Ziebach R et al (2000) Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. Lancet 355:1239–1240PubMedCrossRefGoogle Scholar
  21. 21.
    Ruess L, Blask AR, Bulas DI et al (2000) Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. AJR 175:79–84PubMedGoogle Scholar
  22. 22.
    Spalinger J, Patriquin H, Miron MC et al (2000) Doppler US in patients with Crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 217:787–791PubMedGoogle Scholar
  23. 23.
    Yekeler E, Danalioglu A, Movasseghi B et al (2005) Crohn disease activity evaluated by Doppler ultrasonography of the superior mesenteric artery and the affected small-bowel segments. J Ultrasound Med 24:59–65PubMedGoogle Scholar
  24. 24.
    Miao YM, Koh DM, Amin Z et al (2002) Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease. Clin Radiol 57:913–918PubMedCrossRefGoogle Scholar
  25. 25.
    van Oostayen JA, Wasser MN, van Hogezand RA et al (1997) Doppler sonography evaluation of superior mesenteric artery flow to assess Crohn’s disease activity: correlation with clinical evaluation, Crohn’s disease activity index, and alpha 1-antitrypsin clearance in feces. AJR 168:429–433PubMedGoogle Scholar
  26. 26.
    Scholbach T, Herrero I, Scholbach J (2004) Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects. J Pediatr Gastroenterol Nutr 39:524–528PubMedCrossRefGoogle Scholar
  27. 27.
    Robotti D, Cammarota T, Debani P et al (2004) Activity of Crohn disease: value of Color-Power-Doppler and contrast-enhanced ultrasonography. Abdom Imaging 29:648–652PubMedCrossRefGoogle Scholar
  28. 28.
    Di Sabatino A, Fulle I, Ciccocioppo R et al (2002) Doppler enhancement after intravenous levovist injection in Crohn’s disease. Inflamm Bowel Dis 8:251–257PubMedCrossRefGoogle Scholar
  29. 29.
    Rapaccini GL, Pompili M, Orefice R et al (2004) Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease. Scand J Gastroenterol 39:188–194PubMedCrossRefGoogle Scholar
  30. 30.
    Castiglione F, de Sio I, Cozzolino A et al (2004) Bowel wall thickness at abdominal ultrasound and the one-year-risk of surgery in patients with Crohn’s disease. Am J Gastroenterol 99:1977–1983PubMedCrossRefGoogle Scholar
  31. 31.
    Hirche TO, Russler J, Schroder O et al (2002) The value of routinely performed ultrasonography in patients with Crohn disease. Scand J Gastroenterol 37:1178–1183PubMedCrossRefGoogle Scholar
  32. 32.
    Maconi G, Sampietro GM, Cristaldi M et al (2001) Preoperative characteristics and postoperative behavior of bowel wall on risk of recurrence after conservative surgery in Crohn’s disease: a prospective study. Ann Surg 233:345–352PubMedCrossRefGoogle Scholar
  33. 33.
    DiCandio G, Mosca F, Campatelli A et al (1986) Sonographic detection of postsurgical recurrence of Crohn disease. AJR 146:523–526PubMedGoogle Scholar
  34. 34.
    Andreoli A, Cerro P, Falasco G et al (1998) Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn’s disease. Am J Gastroenterol 93:1117–1121PubMedCrossRefGoogle Scholar
  35. 35.
    Maconi G, Bollani S, Bianchi Porro G (1996) Ultrasonographic detection of intestinal complications in Crohn’s disease. Dig Dis Sci 41:1643–1648PubMedCrossRefGoogle Scholar
  36. 36.
    Maconi G, Radice E, Greco S et al (2006) Bowel ultrasound in Crohn’s disease. Best Pract Res Clin Gastroenterol 20:93–112PubMedCrossRefGoogle Scholar
  37. 37.
    Kratzer W, von Tirpitz C, Mason R et al (2002) Contrast-enhanced power Doppler sonography of the intestinal wall in the differentiation of hypervascularized and hypovascularized intestinal obstructions in patients with Crohn’s disease. J Ultrasound Med 21:149–157PubMedGoogle Scholar
  38. 38.
    Gasche C, Moser G, Turetschek K et al (1999) Transabdominal bowel sonography for the detection of intestinal complications in Crohn’s disease. Gut 44:112–117PubMedCrossRefGoogle Scholar
  39. 39.
    Maconi G, Sampietro GM, Parente F et al (2003) Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study. Am J Gastroenterol 98:1545–1555PubMedCrossRefGoogle Scholar
  40. 40.
    Esteban JM, Aleixandre A, Hurtado MJ et al (2003) Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn’s disease. Eur J Gastroenterol Hepatol 15:253–259PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Marianne Alison
    • 1
  • Ahmed Kheniche
    • 1
  • Robin Azoulay
    • 1
  • Sandrine Roche
    • 1
  • Guy Sebag
    • 1
  • Nadia Belarbi
    • 1
  1. 1.Department of Paediatric Imaging, Hospital Robert DebréParis VII UniversityParisFrance

Personalised recommendations