Background: As part of the diagnostic work-up of Crohn’s disease (CD), imaging studies such as MR-Enterography (MRE), CT-Enterography (CTE) or wireless capsule endoscopy are performed to assess for bowel inflammation and complications. These studies have inherent limitations including high cost, limited availability and technical complexities. Bowel ultrasound (US) is an alternative modality to characterize the involved bowel.
Objective: To compare the diagnostic accuracy of bowel US in treatment-naive pediatric CD patients to advanced imaging modalities.
Study Design: A retrospective study of newly diagnosed pediatric CD patients who had a bowel US preformed within 3 months of diagnosis. All but 2 had an MRE/CTE performed during the same timeframe. Sonographic inflammation was determined based on bowel wall thickness, loss of stratification, presence of lymphadenopathy and complications.
Results: US demonstrated signs of intestinal inflammation in 23/26 (88%) CD patients included in this study. Two of the remaining three patients were diagnosed endoscopically with limited upper tract and colonic disease, and the third had upper tract disease that was diagnosed only by capsule study. Importantly, US demonstrated signs of enteritis in 3 patients with normal endoscopy that were subsequently diagnosed with CD. Bowel US detected CD complications including abscess and fistula formation, but failed to identify luminal stenosis in 6/7 patients.
Conclusions: Bowel US is useful in identifying small bowel inflammation in CD patients, but fails to detect stenosis compared to MRE. Additional studies are required to determine whether it can be used as a screening modality when CD is suspected.
