Investigating the small bowel in pediatric Crohn's disease: Prospective comparative study between small intestine contrast ultrasonography and magnetic resonance imaging

Abstract

Background: Magnetic resonance imaging (MRI) is considered the gold-standard to evaluate SB in pediatric Crohn’s disease (CD). However, MRI is expensive, requires a strong compliance and a considerable amount of oral contrast to distend intestinal lumen. Small intestine contrast ultrasonography (SICUS) is non-invasive, low cost and generally well tolerated by patients. Objectives: To compare the diagnostic accuracy of SICUS and MRI in detecting presence, site and extension of SB disease and in assessing strictures in pediatric CD. Methods: Pediatric pts with suspected or known CD were prospectively enrolled. All underwent SICUS, MRI and ileocolonoscopy, performed by blind different operators. The SB was subdivided into: jejunum, ileum, terminal ileum (TI). The statistic concordance (k) between the two techniques was calculated. For the TI sensitivity (SE) and specificity (SP) were also assessed, with endoscopy as reference standard. The one-way ANOVA was used to compare the disease extension (cm) in the different segments. Results:66 consecutive patientswere included. The overall k for the presence of lesions was=0.94 (ES 0.06; 95%CI 0.8–1. The k for segments was 0.67 (jejunum), 0.91 (ileum) and 0.91 (TI). SE and SP (%) of SICUS andMRI for TI lesions were 98, 100 and 93, 92, respectively. There was no difference (p ns) in the evaluation of disease extension between the two techniques. The k for SB strictures was 0.62. SE and SP (%) of SICUS andMRI for TI strictures were 100, 100 and 92, 87, respectively. MRI provided 7 false positive results. Conclusions: The diagnostic performance of SICUS is comparable to that ofMRI. SICUSmight represent afirst-line tool in pediatric CD, able to reduce costs and to post-pone or even avoid more invasive investigations.