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Small intestine contrast ultrasonography in pediatric Crohn's disease
Nadia Pallotta1, Fortunata Civitelli, Giovanni Di Nardo
1Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy.
Insights
Small intestine contrast ultrasonography (SICUS) accurately detects pediatric Crohn's disease (CD) small bowel lesions, outperforming standard ultrasonography (TUS). This radiation-free method is comparable to radiology for diagnosing pediatric CD.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Inflammatory Bowel Disease
Background:
- Pediatric Crohn's disease (CD) diagnosis relies on various imaging and endoscopic techniques.
- Accurate assessment of small bowel involvement is crucial for effective management of pediatric CD.
Purpose of the Study:
- To evaluate the diagnostic accuracy of small intestine contrast ultrasonography (SICUS) in pediatric Crohn's disease (CD).
- To compare the efficacy of SICUS with transabdominal ultrasonography (TUS) and other diagnostic modalities.
Main Methods:
- A study involving 51 pediatric patients (median age 15 years) with suspected or proven CD.
- Patients underwent transabdominal ultrasonography (TUS), SICUS, small bowel follow-through, and endoscopy.
- SICUS involved oral contrast administration; TUS and SICUS findings were compared against a reference standard diagnosis.
Main Results:
- SICUS demonstrated high sensitivity and specificity (100%) for detecting small bowel lesions in both undiagnosed and proven CD patients.
- SICUS showed almost perfect agreement (k=0.93) for lesion site, superior to TUS (k=0.40-0.68).
- SICUS accurately assessed lesion length, unlike TUS which underestimated it (P = .0001).
Conclusions:
- Small intestine contrast ultrasonography (SICUS) is a radiation-free technique comparable to radiology for pediatric CD.
- SICUS is more accurate than TUS in assessing small bowel lesions, particularly in the proximal region.
- SICUS offers a valuable, accurate, and radiation-free imaging option for pediatric Crohn's disease.
Objective:
To evaluate the diagnostic accuracy of small intestine contrast ultrasonography (SICUS) in pediatric Crohn's disease (CD).
Study Design:
A total of 51 consecutive patients (median age 15 years; range 3-20, 31 male patients), 21 with suspected and 30 with proven CD, were studied. All patients underwent standard ultrasonography (ie, transabdominal ultrasonography [TUS]), SICUS, small bowel follow-through, and upper and lower endoscopy. SICUS was performed in patients after they ingested an oral contrast solution. TUS and SICUS were compared with small bowel follow-through and endoscopy via use of the final diagnosis as reference standard.
Results:
In undiagnosed patients, the sensitivity and specificity of TUS and SICUS in detecting CD small bowel lesions were 75% and 100% and 100% and 100%, respectively. In patients with proven CD, the sensitivity and specificity of TUS and SICUS were 76% and 100% and 96% and 100%, respectively. The agreement (k) with radiology for site of lesions was almost perfect for SICUS (0.93), both for jejunal and ileal lesions, and it was fair (0.40) for jejunal and substantial (0.68) for ileal lesions for TUS. Compared with radiology SICUS correctly assessed the length of lesions, whereas TUS underestimated it (P = .0001).
Conclusions:
The radiation-free technique SICUS is comparable with radiology and more accurate than TUS in assessing small bowel lesions in pediatric CD, mainly in the detection of proximal small bowel disease.
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