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Pediatric inflammatory bowel disease: imaging issues with targeted solutions

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Abstract

To date, there have been many advances in inflammatory bowel disease (IBD) imaging in every cross-sectional imaging modality, particularly in children. The main emphasis in pediatric IBD imaging is on robust and reproducible measures of small bowel Crohn’s disease inflammation, accurate diagnosis of IBD-related complications, and minimizing radiation burden to the patient, as repeat imaging is necessary over the course of their disease. In this article, we discuss the current state-of-the-art imaging techniques, in addition to routine fluoroscopy, including MR and CT enterography and bowel ultrasound. We also present the emerging use of new methods to characterize disease severity and distinguish active inflammation from fibrosis such as diffusion-weighted imaging, bowel elastography, and contrast-enhanced ultrasound. The diagnostic performance of particular examinations, their strengths and weaknesses, and role in IBD management will be discussed. Although these advanced imaging techniques applied to children are similar to those performed in adults, special considerations related to their application in pediatric patients will also be reviewed.

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Acknowledgments

We would like to thank the many members of the Society of Abdominal Radiology Crohn’s Disease-focused Panel, who have contributed ideas and provided the impetus for the writing of the manuscript. A special thank you goes to Alec Megibow, JG Fletcher, and Jeff Fidler for their leadership and editorial assistance, and insuring that pediatric IBD patients are afforded the best possible care.

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Authors and Affiliations

  1. Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA

    Sudha A. Anupindi & Kassa Darge

  2. Department of Radiology, Nemours Children’s Hospital, Orlando, FL, 32827, USA

    Daniel J. Podberesky

  3. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45241, USA

    Alexander J. Towbin

  4. Department of Radiology, UCSF Benioff Children’s Hospital, San Francisco, CA, 94121, USA

    Jesse Courtier

  5. Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02114, USA

    Michael S. Gee

  6. Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI, 48109, USA

    Jonathan R. Dillman

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  1. Sudha A. Anupindi
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  2. Daniel J. Podberesky
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  3. Alexander J. Towbin
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  4. Jesse Courtier
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  5. Michael S. Gee
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  6. Kassa Darge
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  7. Jonathan R. Dillman
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Correspondence to Sudha A. Anupindi.

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Anupindi, S.A., Podberesky, D.J., Towbin, A.J. et al. Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging 40, 975–992 (2015). https://doi.org/10.1007/s00261-015-0423-y

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