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Updated: May 11, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Systematic review: MRI enterography for assessment of small bowel involvement in paediatric Crohn's disease
E Giles1, A R Barclay, S Chippington
1Paediatric Gastroenterology, Barts and the London School of Medicine and Dentistry, London, UK.
Background:
Barium meal enteroclysis (BM) is the recommended imaging technique for small bowel inaccessible by ileo-colonoscopy when diagnosing paediatric-onset inflammatory bowel disease, but it has poor sensitivity and involves ionising radiation. MRI enterography (MRE) is an alternative methodology.
Aims:
To critically appraise the published evidence on MRE in the assessment of Paediatric inflammatory bowel disease by systematic review.
Methods:
Review of all English language data reporting MRE for the investigation of patients <18 years with known or suspected IBD. Primary searches of Medline (Jan 1950-April 2012), Cinahl (1966-April 2012) and Pubmed (Jan 1950-April 2012) were performed using keyword and MeSH terms; IBD; Magnetic resonance imaging; small bowel imaging; EMBASE was then searched. Two authors independently assessed the quality of studies using the quality assessment of diagnostic accuracy studies tool.
Results:
Searches yielded 930 035 hits, combination word searches limited to 1983 titles. Fifty-two studies were fully reviewed, 41 were excluded due to lack of paediatric data. Eleven studies of 496 children were included. All studies used endoscopy as the reference test. 10/496 patients required jejunal intubation for bowel preparation. Meta-analysis of six comparable studies gave a pooled sensitivity and specificity for MRE detection of active terminal ileal Crohn's disease of 84% and 97% respectively. Studies displayed heterogeneity in bowel preparation, scanning technique, reporting methodology and timing of ileo-colonoscopy in relation to MRE. In three studies comparing BM, MRE had greater sensitivity and specificity.
Conclusions:
MRE is a sensitive and specific tool for diagnosis in paediatric inflammatory bowel disease. Technical considerations require refinement and standardisation; however, MRE has no radiation. Current data suggest that MRE should supersede BM as the SB imaging technique in centres with appropriate expertise.
Insights
Magnetic resonance imaging enterography (MRE) is a sensitive and specific tool for diagnosing pediatric inflammatory bowel disease (IBD) without radiation. It shows promise to replace barium meal enteroclysis for small bowel imaging in children.
Area of Science:
- Radiology
- Pediatric Gastroenterology
- Diagnostic Imaging
Background:
- Barium meal enteroclysis (BM) is recommended for pediatric inflammatory bowel disease (IBD) but has low sensitivity and uses radiation.
- Magnetic resonance imaging enterography (MRE) offers an alternative imaging methodology for small bowel assessment.
Purpose of the Study:
- To systematically review and critically appraise the evidence for MRE in assessing pediatric IBD.
Main Methods:
- Systematic review of English-language studies on MRE for patients under 18 with IBD.
- Searches conducted on Medline, Cinahl, Pubmed, and EMBASE databases.
- Quality assessment of diagnostic accuracy studies tool used; two authors independently assessed studies.
Main Results:
- Eleven studies involving 496 children were included; endoscopy served as the reference standard.
- Meta-analysis of six studies showed MRE sensitivity of 84% and specificity of 97% for active terminal ileal Crohn's disease.
- MRE demonstrated greater sensitivity and specificity compared to BM in three comparative studies.
Conclusions:
- MRE is a sensitive and specific diagnostic tool for pediatric IBD, offering a radiation-free alternative.
- Standardization of MRE techniques is needed, but it should supersede BM for small bowel imaging in expert centers.
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