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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Duigenan S, Gee MS. Imaging of pediatric patients with inflammatory bowel disease. [Review]. AJR Am J Roentgenol. 199(4):907-15, 2012 Oct. Review/Other-Dx N/A To examine the current imaging literature and develop basic imaging guidelines for evaluation of children with IBD. Imaging of pediatric patients with IBD must balance considerations of diagnostic accuracy against concerns about patient exposure to ionizing radiation and tolerance of the imaging technique. The imaging modality chosen depends on the clinical presentation and expected pathologic finding. 4
2. Panes J, Bouhnik Y, Reinisch W, et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis. 7(7):556-85, 2013 Aug. Review/Other-Dx N/A To establish standards for imaging in IBD using magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US), and including also other radiologic procedures such as conventional radiology or nuclear medicine examinations, but not endoscopy, although considerations on the relative value of endoscopy and radiology in different clinical settings are provided in the consensus No results stated in abstract 4
3. Towbin AJ, Sullivan J, Denson LA, Wallihan DB, Podberesky DJ. CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics. 33(7):1843-60, 2013 Nov-Dec. Review/Other-Dx N/A To discuss the use of computed tomographic (CT) enterography and magnetic resonance (MR) enterography in the context of pediatric IBD in terms of advantages and disadvantages, protocol, and imaging findings. No results stated in the abstract. 4
4. Rosen MJ, Dhawan A, Saeed SA. Inflammatory Bowel Disease in Children and Adolescents. JAMA Pediatr 2015;169:1053-60. Review/Other-Dx N/A To provide a contemporary overview of the epidemiologic features, pathogenesis, diagnosis, and management of inflammatory bowel diseases (IBD) in children and adolescents. No results stated in the abstract. 4
5. Compton GL, Bartlett M. Perianal disease in pediatric Crohn disease: a review of MRI findings. [Review]. Pediatr Radiol. 44(10):1198-208; quiz 1195-7, 2014 Oct. Review/Other-Dx N/A To review magnetic resonance imaging (MRI) findings regarding perianal disease in pediatrics with Crohn disease. No results stated in the abstract. 4
6. Shenoy-Bhangle A, Gee MS. Magnetic resonance imaging of perianal Crohn disease in children. [Review]. Pediatr Radiol. 46(6):838-46, 2016 May. Review/Other-Dx N/A To discuss the role of magnetic resonance imaging (MRI) in initial diagnosis and follow-up of perianal fistulizing Crohn disease in the pediatric population. No results stated in the abstract. 4
7. Greer ML.. How we do it: MR enterography. [Review]. Pediatr Radiol. 46(6):818-28, 2016 May. Review/Other-Dx N/A To discuss how magnetic resonance enterography (MRE) now plays a central role in diagnosing pediatric inflammatory bowel disease (IBD), and its role in other intestinal pathologies such as scleroderma is gradually expanding. No results stated in the abstract. 4
8. Schreyer AG, Geissler A, Albrich H, et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn's disease. Clin Gastroenterol Hepatol. 2004;2(6):491-497. Observational-Dx 21 patients Prospective study to evaluate the diagnostic efficacy of abdominal MRI of the small bowel after drinking contrast agent only compared with conventional enteroclysis and abdominal MRI performed after enteroclysis in patients with suspected or proven CD. All pathological findings on conventional enteroclysis were shown correctly on MR after enteroclysis and MR after oral contrast only. Additional information by MR was obtained in 6/21 patients. 1
9. Brown S, Applegate KE, Sandrasegaran K, et al. Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility. Pediatr Radiol. 38(5):497-510, 2008 May. Observational-Dx 112 FE and 74 CT enteroclysis studies performed in 175 children Retrospective review to evaluate the feasibility, safety, and techniques of FE and CT enteroclysis, and to review their indications and findings in children. FE and CT enteroclysis studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CT enteroclysis 29%) and abdominal pain (FE 26%, CT enteroclysis 26%). The findings were normal in 54% of the FE studies and 46% of the CT enteroclysis studies. Most common small bowel diagnoses were Crohn’s disease (FE 34%, CT enteroclysis 28%) and partial SBO (FE 3%, CT enteroclysis 10%). Overall, 14 and 21 patients had surgery as a result of the findings of FE and CT enteroclysis, respectively. FE and CT enteroclysis are safe, feasible, and accurate in depicting small-bowel pathology in children. 3
10. Jaimes C, Gee MS. Strategies to minimize sedation in pediatric body magnetic resonance imaging. Pediatr Radiol 2016;46:916-27. Review/Other-Dx N/A To discuss various methods to minimize sedation in pediatric body magnetic resonance imaging. No results stated in the abstract. 4
11. Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS. Detecting active inflammation and fibrosis in pediatric Crohn's disease: prospective evaluation of MR-E and CT-E. Abdom Imaging. 38(4):705-13, 2013 Aug. Observational-Dx 12 patients To compare the ability of MR enterography (MR-E) and CT enterography (CT-E) to assess for active inflammation and mural fibrosis in patients with known Crohn Disease (CD) as compared to a histologic reference standard. We found that while CT-E and MR-E were similar in their accuracies of depicting active inflammation, MR-E was significantly more sensitive in detecting fibrosis. Because of this and the lack of ionizing radiation from MR-E, we believe that MR-E rather than CT-E should serve as the primary imaging modality for the assessment of CD pediatric patients with non-acute clinical exacerbations. 2
12. Siddiki HA, Fidler JL, Fletcher JG, et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol. 2009;193(1):113-121. Observational-Dx 33 patients, 4 independent reviewers: 2 for MR enterography 2 for CT enterography Blinded prospective study. To obtain pilot data on the accuracy of MR enterography for detecting small-bowel CD compared with CT enterography and with a clinical reference standard based on imaging, clinical information, and ileocolonoscopy. All 33 patients underwent CT enterography and ileocolonoscopy, 30 of whom also underwent MR enterography. Sensitivities of MR enterography and CT enterography for detecting active small-bowel CD were similar (90.5% vs 95.2%, respectively; P=0.32). The image quality scores for MR enterography examinations were significantly lower than those for CT enterography (P=0.005). MR enterography and CT enterography identified 8 cases (24%) with a final diagnosis of active small-bowel inflammation in which the ileal mucosa appeared normal at ileocolonoscopy. Furthermore, enterography provided the only available imaging in 3 additional patients who did not have ileal intubation. MR enterography and CT enterography have similar sensitivities for detecting active small-bowel inflammation, but image quality across the study cohort was better with CT. Cross-sectional enterography provides complementary information to ileocolonoscopy. 2
13. Lee SS, Kim AY, Yang SK, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology. 2009;251(3):751-761. Observational-Dx 30 patients with CD, 2 independent readers To prospectively compare the accuracy of CT and MR enterography and SBFT examination for detection of active small-bowel inflammation and extraenteric complications in patients with CD. Ileocolonoscopic findings served as the reference standard. Readers were blinded to clinical findings, findings at ileocolonoscopic assessment, and results of other imaging examinations. Differences in areas under the ROC curves for CT enterography (0.900 and 0.894), MR enterography (0.933 and 0.950), and SBFT (0.883 and 0.928) for readers 1 and 2, respectively, in the detection of active terminal ileitis were not significant (P>.017). Sensitivity values for detection of extraenteric complications were significantly higher for CT and MR enterography (100% for both) than they were for SBFT (32% for reader 1 and 37% for reader 2) (P<.001). Because MR enterography has a diagnostic effectiveness comparable to that of CT enterography, this technique has potential to be used as a radiation-free alternative for evaluation of patients with CD. 1
14. Qiu Y, Mao R, Chen BL, et al. Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease. [Review]. Aliment Pharmacol Ther. 40(2):134-46, 2014 Jul. Meta-analysis 6 studies, 290 patients To compare the overall diagnostic accuracy in assessing the activity of small bowel and complications. A total of 290 CD patients from six different studies were analysed. The pooled sensitivity and specificity for MRE in detecting active small bowel CD was87.9% [95% confidence interval (CI), 81.8–92.5] and 81.2% (95% CI: 71.9–88.4) respectively. The AUC under the summary receiver-operating characteristic(sROC) of MRE was 0.905 (SEM 0.03, standard error of the mean). Likewise, the pooled sensitivity and specificity of CTE in detecting active small bowel CDwas 85.8% (95% CI: 79.2–90.9) and 83.6% (95% CI: 75.3–90.1) with the AUC of 0.898. The AUC of MRE in detecting fistula, stenosis and abscess was 0.936,0.931 and 0.996, respectively, compared to 0.963, 0.616 and 0.899 of CTE. No statistically significant IY for MRE vs. CTE was found (fixed model, P > 0.05). Good
15. Bruining DH, Zimmermann EM, Loftus EV Jr, et al. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Radiology. 286(3):776-799, 2018 Mar. Review/Other-Dx N/A To provide consensus recommendations for evaluation, interpretation and utlization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn's disease. No results stated in abstract. 4
16. Gale HI, Sharatz SM, Taphey M, Bradley WF, Nimkin K, Gee MS. Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol. 47(10):1321-1328, 2017 Sep. Observational-Dx 84 patients To evaluate the performance of established imaging features of active Crohn disease in children and adolescents on computed tomography (CT) and magnetic resonance (MR) enterography compared with histological reference. We evaluated 452 bowel segments (135 from CT enterography, 317 from MR enterography) from 84 patients. Mural imaging features had the highest association with active inflammation both for MR enterography (wall thickening had 80% accuracy, 69% sensitivity and 91% specificity; mural hyperenhancement had 78%, 53% and 96%, respectively) and CT enterography (wall thickening had 84% accuracy, 72% sensitivity and 91% specificity; mural hyperenhancement had 76%, 51% and 91%, respectively), with perienteric imaging features performing significantly worse on MR enterography relative to CT enterography (P < 0.001). 3
17. Gee MS, Nimkin K, Hsu M, et al. Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol. 197(1):224-31, 2011 Jul. Observational-Dx 21 patients A prospective evaluation of MR enterographic accuracy for detecting CD imaging features in pediatric patients, compared with a CT reference standard, as well as determination of MR enterographic accuracy for detecting active bowel inflammation and fibrosis using a histologic reference standard. All 21 subjects underwent MR enterography and histologic sampling, 18 of whom also underwent CT. MR enterography had high sensitivity for detecting CD imaging features (eg, bowel wall thickening, mesenteric inflammation, lymphadenopathy, fistula, and abscess) compared with CT, with individual sensitivity values ranging from 85.1% to 100%. Of a total of 53 abnormal bowel segments with correlation of MRI and histologic findings, MR enterography showed 86.7% accuracy (90.0% sensitivity and 82.6% specificity) for detecting active inflammation (P<0.001). The accuracy of MR enterography for detecting mural fibrosis overall was 64.9%, compared with histology, but increased to 83.3% (P<0.05) for detecting fibrosis without superimposed active inflammation. 1
18. Treglia G, Quartuccio N, Sadeghi R, et al. Diagnostic performance of Fluorine-18-Fluorodeoxyglucose positron emission tomography in patients with chronic inflammatory bowel disease: a systematic review and a meta-analysis. [Review]. J Crohns Colitis. 7(5):345-54, 2013 Jun. Meta-analysis 19 studies (454 patients) To systematically review and meta-analyze published data about the diagnostic performance of Fluorine-18-Fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in patients with chronic inflammatory bowel disease (IBD). Nineteen studies comprising 454 patients with suspected IBD were included in the qualitative analysis (systematic review) and discussed. The quantitative analysis (meta-analysis) of seven selected studies (including 219 patients with IBD) provided the following results on a per segment-based analysis: sensitivity was 85% [95% confidence interval (95%CI) 81–88%], specificity 87% (95%CI 84–90%), LR + 6.19 (95%CI: 2.86–13.41), LR - 0.19 (95%CI: 0.10–0.34), and DOR 44.35 (95%CI: 11.77–167.07). The area under the ROC curve was 0.933. Good
19. Berthold LD, Steiner D, Scholz D, Alzen G, Zimmer KP. Imaging of chronic inflammatory bowel disease with 18F-FDG PET in children and adolescents. Klin Padiatr. 225(4):212-7, 2013 Jul. Observational-Dx 23 children (13 male, 10 female) To determine the value of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in pediatric patients with mild to moderate inflammatory bowel disease (IBD). Superficial gastric lesions were missed, gastric ulcerations were detected. For the stomach, the sensitivity was 0.25, the specificity was 1.00, the positive predictive value was 1.00, for the lower intestine (terminal ileum and colon) the values were 0.74, 0.88, and 0.96; for the terminal ileum 0.89, 0.75 and 0.94, respectively. 3
20. Domina JG, Dillman JR, Adler J, et al. Imaging trends and radiation exposure in pediatric inflammatory bowel disease at an academic children's hospital. AJR Am J Roentgenol. 201(1):W133-40, 2013 Jul. Observational-Dx 982 patients To retrospectively evaluate diagnostic imaging trends and radiation exposure in pediatric inflammatory bowel disease (IBD) at a U.S. academic children's hospital between 2001 and 2010. There was a 53% increase in the average number of abdominopelvic diagnostic examinations obtained per pediatric IBD patient comparing 2001 with 2010 (1.29 ± 2.19 vs 1.98 ± 3.46, p = 0.004). Abdominal radiography (p = 0.02), MRI (p < 0.0001), and esophagogastroduodenoscopy (EGD) (p = 0.01) showed significantly increased use. The increase in use of CT and ileocolonoscopy was not significant (p > 0.05). There was significantly reduced use of contrast enema, small-bowel follow-through (SBFT), and upper gastrointestinal (UGI) series (all, p < 0.0001). The average pediatric IBD patient seen in 2010 (mean age, 13.9 years) had undergone 1.08 CT, 0.82 MRI, 1.36 abdominal radiographic, 0.14 contrast enema, 0.52 SBFT, 0.54 UGI, 1.00 ileocolonoscopy, and 0.72 EGD examinations during his or her lifetime, with an average cumulative lifetime estimated effective radiation dose of 4.6 mSv. 3
21. Barber JL, Shah N, Watson TA. Early onset inflammatory bowel disease - What the radiologist needs to know. [Review]. Eur J Radiol. 106:173-182, 2018 Sep. Review/Other-Dx N/A To outline the key clinical features, underlying causes, differential diagnoses and imaging investigation of early onset inflammatory bowel disease (EOIBD), with an emphasis on the key differences between this and inflammatory bowel disease (IBD) presenting in the adult or adolescent. No results stated in the abstract. 4
22. Giles E, Hanci O, McLean A, et al. Optimal assessment of paediatric IBD with MRI and barium follow-through. J Pediatr Gastroenterol Nutr. 54(6):758-62, 2012 Jun. Observational-Dx 87 patients To compare barium follow-through (BaFT) and a new abdominal magnetic resonance imaging (MRI) protocol in a paediatric inflammatory bowel disease (IBD) population. Eighty-seven patients underwent both BaFT and MRI abdomen. Thirty-one percent of patients had additional pathology on MRI, not seen on the BaFT. Sixty-seven percent of patients (n=59) had an MRI finding equivalent to BaFT. Using histology as a criterion standard for detecting terminal ileal disease, BaFT had a sensitivity and specificity of 76% and 67%, and MRI had a sensitivity and specificity of 83% and 95%, respectively. 3
23. Mojtahed A, Gee MS. Magnetic resonance enterography evaluation of Crohn disease activity and mucosal healing in young patients. [Review]. Pediatr Radiol. 48(9):1273-1279, 2018 08. Review/Other-Dx N/A To summarize the current evidence supporting the use of magnetic resonance enterography features as imaging biomarkers of Crohn disease activity and treatment response. No results stated in the abstract. 4
24. Absah I, Bruining DH, Matsumoto JM, et al. MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image quality, and initial performance estimates. AJR Am J Roentgenol. 199(3):W367-75, 2012 Sep. Observational-Dx 70 patients To evaluate image quality, oral contrast administration and bowel distention, side effects, and performance estimates of MR enterography in a large cohort of pediatric patients with inflammatory bowel disease (IBD). Eighty-five MR enterography studies were performed without sedation in 70 patients (mean age, 15.6 years; age range, 9–18 years) over 30 months. The mean image quality for unenhanced images was significantly higher than for contrast-enhanced images (4.7 vs 4.1, p <0.0001), with unacceptable image quality occurring on both unenhanced and contrast-enhanced sequences in one patient. The amount of oral contrast material ingested correlated with patient age (p = 0.009), with acceptable bowel distention occurring in 93% (78/85). Two patients had nausea or emesis and one experienced a syncopal episode after MR enterography. Sensitivity and specificity of MR enterography for active disease of the terminal ileum, right colon, and left colon were 80% and 85.2%, 79.1% and 77.8%, and 90.3% and 63.6%, respectively. 3
25. Dillman JR, Ladino-Torres MF, Adler J, et al. Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol. 41(12):1552-8, 2011 Dec. Observational-Dx 31 subjects To assess the ability of MR enterography to identify segments of small bowel and colon affected by pediatric CD using histopathology as the reference standard. 32 pediatric MR enterography examinations were identified with correlative histopathology. MR enterography had an overall sensitivity of 94% for detecting the presence of CD, in general. At the bowel segmental level, MR enterography had a sensitivity of 66%, specificity of 90%, PPV of 85% and NPV of 76%. The terminal ileum was abnormal by MR enterography in 11/15 (73%) subjects lacking a diagnostic biopsy of this bowel segment. 3
26. Maccioni F, Al Ansari N, Mazzamurro F, et al. Detection of Crohn disease lesions of the small and large bowel in pediatric patients: diagnostic value of MR enterography versus reference examinations. AJR Am J Roentgenol. 203(5):W533-42, 2014 Nov. Observational-Dx 50 children (24 girls and 26 boys) To prospectively determine the accuracy of MR enterography in detecting Crohn disease lesions from the jejunum to the anorectal region in pediatric patients, in comparison with main reference investigations. MR enterography detected lesions in 164 of 450 segments, with 155 true-positive and nine false-positive findings; overall sensitivity, specificity, and positive and negative predictive values for small- and large-bowel lesions were 94.5%, 97%, 94.5%, and 97%, respectively (? = 0.93; 95% CI, 0.89–0.97). Sensitivity and specificity values were 88% and 97%, respectively, for the jejunum, 100% and 97% for the proximal-to-mid ileum, 100% and 100% for the distal ileum, 93% and 100% for the cecum, 70% and 97% for the ascending colon, 80% and 100% for the transverse colon, 100% and 92% for the descending colon, 96% and 90% for the sigmoid colon, and 96% and 88% for the rectum. From jejunum to rectum, the AUC value ranged between 0.916 (jejunum) and 1.00 (distal ileum). Perianal fistulas were diagnosed in 15 patients, and other complications were found in 13 patients. 2
27. Wallihan DB, Towbin AJ, Denson LA, Salisbury S, Podberesky DJ. Inflammatory bowel disease in children and adolescents: assessing the diagnostic performance and interreader agreement of magnetic resonance enterography compared to histopathology. Acad Radiol. 19(7):819-26, 2012 Jul. Observational-Dx 91 patients To determine the accuracy of MR enterography compared to histopathology in the evaluation of pediatric IBD and to assess interreader reliability for image interpretation. A total of 91 MR enterography studies were reviewed. Of these, 45 had comparison histopathology within 45 days. The overall sensitivity of MR enterography for detecting active inflammation compared to ileocolonoscopy was 92% for both readers, while specificity was 100% for reader 1 and 75% for reader 2. Of the individual parameters evaluated, mucosal hyperenhancement and bowel wall thickening were the most sensitive indicators of active inflammation, each having sensitivity of 86% and specificity of 88%. Cohen's kappa coefficient was 0.59, indicating moderate agreement between the readers. 2
28. Kim SJ, Ratchford TL, Buchanan PM, et al. Diagnostic accuracy of non-contrast magnetic resonance enterography in detecting active bowel inflammation in pediatric patients with diagnosed or suspected inflammatory bowel disease to determine necessity of gadolinium-based contrast agents. Pediatr Radiol. 49(6):759-769, 2019 05. Observational-Dx 77 patients To determine whether gadolinium-based contrast agents are necessary in assessing active bowel inflammation on magnetic resonance enterography (MRE) in pediatric patients with known or suspected inflammatory bowel disease (IBD). The pre- and pre-/post-contrast-enhanced MRE vs. combined endoscopic/histopathological results had moderate agreement (85.7%; ? 0.713, P<0.001; P-value 0.549). Compared to combined endoscopy/histopathology, pre- vs. pre-/post-contrast sensitivity (67%, confidence interval [CI] 0.53-0.79 vs. 67%, CI 0.53-0.79) and specificity (80%, CI 0.59-0.92 vs. 68%, CI 0.46-0.84) varied little (? 0.42, P<0.001 and ? 0.32, P=0.003, respectively). The three readers had moderate agreement (85.2%; ? 0.695, P=0.001; P-value 0.625). More penetrating complications were identified following contrast administration (P-value 0.04). 2
29. Lanier MH, Shetty AS, Salter A, Khanna G. Evaluation of noncontrast MR enterography for pediatric inflammatory bowel disease assessment. J Magn Reson Imaging. 48(2):341-348, 2018 08. Observational-Dx 52 children To determine the impact of intravenous (IV) gadolinium in assessment of pediatric inflammatory bowel disease (IBD) by contrast-enhanced MR enterography (MRE). In all, 52 children (46% female), mean age 13.2 (SD 3.42) years formed the study cohort. 77% (40/52) had inflammation on endoscopic biopsy. Pre/post-MRE showed no significant increase in the c-statistic compared to pre-MRE for assessment of small bowel (Reader 1 P = 0.56, Reader 2 P = 1.00) or large bowel inflammation (Reader 1 P = 0.42, Reader 2 P = 1.00)). Intravenous contrast showed no improvement in interobserver agreement for assessment of inflammation in small (kappa 0.92 pre-MRE, 0.88 pre/post-MRE) or large bowel (kappa 0.83 pre-MRE, 0.73 pre/post-MRE). IV contrast had no meaningful impact on interobserver agreement for length of small bowel inflamed (intraclass correlation coefficient 0.90 pre-MRE, 0.95 pre/post-MRE). Assessment of IBD complications was improved with IV contrast, with 3/5 cases with perianal penetrating disease not recognized on pre-MRE. 2
30. Neubauer H, Pabst T, Dick A, et al. Small-bowel MRI in children and young adults with Crohn disease: retrospective head-to-head comparison of contrast-enhanced and diffusion-weighted MRI. Pediatr Radiol. 43(1):103-14, 2013 Jan. Observational-Dx 60 patients To evaluate free-breathing diffusion-weighted imaging (DWI) , as compared to contrast-enhanced magnetic resonance imaging (MRI), in children, adolescents and young adults with Crohn disease. DWI and contrast-enhanced MRI correctly identified 32 and 31 patients, respectively. All 22 small-bowel lesions and all Crohn complications were detected. False-positive findings (two on DWI, one on contrast-enhanced MRI), compared to colonoscopy, were a result of large-bowel lumen collapse. Inflammatory wall thickening was comparable on DWI and contrast-enhanced MRI. DWI was superior to contrast-enhanced MRI for detection of lesions in 27% of the assessed bowel segments and equal to contrast-enhanced MRI in 71% of segments. 3
31. Jesuratnam-Nielsen K, Logager VB, Rezanavaz-Gheshlagh B, Munkholm P, Thomsen HS. Plain magnetic resonance imaging as an alternative in evaluating inflammation and bowel damage in inflammatory bowel disease--a prospective comparison with conventional magnetic resonance follow-through. Scand J Gastroenterol. 50(5):519-27, 2015 May. Observational-Dx 100 patients To compare prospectively the diagnostic accuracy of magnetic resonance imaging (MRI) without use of contrast medium orally or intravenously (plain MRI) with magnetic resonance follow-through (MRFT) in patients with inflammatory bowel disease (IBD) A total of 100 patients (40 males and 60 females; median age: 38.5; range: 19–90) were enrolled; 44 withCrohn’s disease (CD), 25 with ulcerative colitis (UC), 24 with IBD unclassified (IBD-U), and 7 had other diagnosis.Sensitivity, specificity, and accuracy in CD ranged 50–86%, 93–94%, and 91–92% for wall thickening and 49–82%, 85–93%,and 84–89% for DWI, respectively. Sensitivity, specificity, and accuracy in UC range 0–40%, 87–100%, and 80–100% for wallthickening and 0–52%, 83–94% and 76–92% for DWI, respectively. The k values for bowel wall thickening, DWI, and muralhyperenhancement were detected with fair agreement (k = 0.26–0.39) at both MRI examinations, whereas only bowel wallthickening in MRFT were detected with moderate agreement (k = 0.47) 2
32. Biko DM, Rosenbaum DG, Anupindi SA. Ultrasound features of pediatric Crohn disease: a guide for case interpretation. [Review]. Pediatr Radiol. 45(10):1557-66; quiz 1554-6, 2015 Sep. Review/Other-Dx N/A To provide a primer of the characteristic intramural and extramural ultrasound (US) findings in children with Crohn disease to serve as a practical and systematic guide to interpretation. No results stated in the abstract. 4
33. Dong J, Wang H, Zhao J, et al. Ultrasound as a diagnostic tool in detecting active Crohn's disease: a meta-analysis of prospective studies. [Review]. Eur Radiol. 24(1):26-33, 2014 Jan. Meta-analysis 15 studies involving 1558 patients To evaluate the diagnostic accuracy of ultrasound in assessing active Crohn’s disease (CD) in adults. Fifteen studies involving 1,558 patients were included in this meta-analysis. Overall, the pooled sensitivity (0.88) and LR- (0.14) were not heterogeneous, whereas the pooled specificity (0.97, I2=72.9 %) and LR+(15.10, I2=71.8 %) were. The DOR of ultrasound for assessing active CD was 121.70, with significant heterogeneity (I2=63.3 %). A symmetrical summary ROC curve was plotted showing that the area under the curve was 0.94, indicating good diagnostic accuracy. Meta-regression and subgroup analysis showed that the disease location may be a major cause of heterogeneity. Good
34. Barber JL, Maclachlan J, Planche K, et al. There is good agreement between MR enterography and bowel ultrasound with regards to disease location and activity in paediatric inflammatory bowel disease. Clin Radiol. 72(7):590-597, 2017 Jul. Observational-Dx 49 patients To investigate concordance of bowel ultrasound and magnetic resonance enterography (MRE) in identifying active disease in children with inflammatory bowel disease. Forty-nine patients (median age 14 years, 33 male) met the inclusion criteria, and 31 children also had endoscopy within 30 days. Active inflammation was seen in 17.6% of bowel segments at ultrasound and 17.3% at MRE. There was good agreement between ultrasound and MRE on the location and activity of disease (Cohen's kappa 0.75, 95% confidence interval [CI]: 0.66-0.83). One patient had an inflammatory phlegmon detected at MRE only; there was no other significant discrepancy in identifying complications. In patients with histopathology, MRE, and ultrasound demonstrated high specificity 85.1% (77.9-90.6) and 86.6% (79.6-91.8) at the bowel segment level. Technical difficulties, including poor tolerance of oral contrast medium and movement, were more common in MRE. 3
35. Ahmad TM, Greer ML, Walters TD, Navarro OM. Bowel Sonography and MR Enterography in Children. AJR Am J Roentgenol. 206(1):173-81, 2016 Jan. Observational-Dx 33 children To assess the diagnostic agreement between bowel sonography and MR enterography in children with suspected or confirmed inflammatory bowel disease (IBD). Sonographic readings are substantially reliable in the colon and terminal and distal ileum (ICC = 0.79-0.88) but are highly unreliable in the mid and proximal small bowel. MR enterography has moderate to almost perfect reliability for all bowel segments (ICC = 0.43-0.96). Sonography was in substantial agreement with MR enterography in most of the large bowel (KCC = 0.67-0.83) and terminal and distal ileum (KCC = 0.75) and in moderate agreement in the remaining bowel segments (KCC = 0.45-0.48). Sonographic findings are specific for disease using MR enterography as the reference standard in all bowel segments (0.83-1.00), but sensitivity markedly varies according to disease location. 2
36. Tsai TL, Marine MB, Wanner MR, et al. Can ultrasound be used as the primary imaging in children with suspected Crohn disease?. Pediatr Radiol. 47(8):917-923, 2017 Jul. Observational-Dx 41 patients To determine if ultrasound (US) can be used for screening evaluation of pediatric Crohn disease. Forty-one patients (mean age: 13.7 years: 4.6-18.9 years) were evaluated. Mean BMI was 21.2 (range: 13-40.2); 10 patients (24.3%) were either overweight or obese. Final diagnoses were Crohn disease (n=24), ulcerative colitis (n=4) and normal/non-inflammatory bowel disease-related diagnoses (n=13). US demonstrated sensitivity of 67% and 78% and specificity of 78% and 83%, by Reader 1 and Reader 2, respectively. MRE sensitivity and specificity were 75% and 100%, respectively, compared to final clinicopathological diagnosis. Interobserver agreement between Reader 1 and Reader 2 was good (0.6< kappa <0.8). 2
37. Zhu C, Ma X, Xue L, et al. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis. [Review]. Medicine (Baltimore). 95(31):e4235, 2016 Aug. Meta-analysis 13 articles To evaluate the diagnostic accuracy of Small intestine contrast ultrasonography (SICUS) in the detection and assessment of small-bowel lesions and complications in Crohn disease (CD). Thirteen articles were finally considered eligible. The pooled sensitivity and specificity of SICUS in detecting small-bowel lesions were 0.883 (95% confidence interval (CI) 0.847–0.913) and 0.861 (95% CI 0.828–0.890), respectively. The pooled diagnostic odds ratio was 39.123 (95% CI 20.014–76.476) and the area under the curve of summary receiver operating characteristic was 0.9273 (standard error: 0.0152). In subgroup analyses, SICUS represented fine sensitivity and specificity in proximal and distal small intestine lesion, as well as in CD-related complications such as stricture, dilation, abscess, and fistula. Good
38. Aloi M, Di Nardo G, Romano G, et al. Magnetic resonance enterography, small-intestine contrast US, and capsule endoscopy to evaluate the small bowel in pediatric Crohn's disease: a prospective, blinded, comparison study. Gastrointest Endosc. 81(2):420-7, 2015 Feb. Observational-Dx 25 patients To assess sensitivity, specificity, and accuracy of magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and capsule endoscopy (CE) in the diagnosis of pediatric small -bowel (SB)-crohn disease (CD). Twenty-five patients completed the study. In the jejunum, the sensitivity of SICUS and CE was 92%, which was not significantly higher than MRE (75%); the specificity of CE (61%) was significantly lower than that of MRE (P = .04). In the proximal and mid ileum, MRE and CE did not have significantly higher sensitivity (100%) than SICUS (80%), but CE was less specific (P > .05). At the terminal ileum, SICUS and MRE were slightly more sensitive than CE (94% vs. 81%); however, the latter was more specific. 2
39. Quaia E, De Paoli L, Stocca T, Cabibbo B, Casagrande F, Cova MA. The value of small bowel wall contrast enhancement after sulfur hexafluoride-filled microbubble injection to differentiate inflammatory from fibrotic strictures in patients with Crohn's disease. Ultrasound Med Biol. 38(8):1324-32, 2012 Aug. Observational-Dx 28 patients (17 male, 11 female) To analyse the value of contrast-enhanced ultrasound to differentiate inflammatory from fibrotic ileal strictures in patients with Crohn's disease (CD). In each patient, the terminal ileal loop was scanned by a convex-array probe (2–5 MHz) before and after sulphur hexafluoride-filled microbubble injection.The digital cine-clip registered after microbubble injection during the first-pass dynamic enhancement was quantified in gray-scale levels by a dedicated software through manually drawn regions-of-interest (ROIs) encompassing the anterior bowel wall. Time-intensity curves from patients with inflammatory and fibrotic ileal strictures, fitted according to the theoretical gamma variate curve, were compared. Inflammatory vs. fibrotic ileal strictures differed in the percentage of maximal enhancement (45.86 ± 5.32 vs. 37.33 ± 16.24%; p , 0.05) and area under the enhancement curve (1168.25 ± 437.65 vs. 570.47 ± 323.08; p , 0.05), whereas the difference in time to peak enhancement was found not significant (9.25 ± 4.21 vs. 12.01 ± 7.34 s; p.0.05). 2
40. De Franco A, Di Veronica A, Armuzzi A, et al. Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity. Radiology. 262(2):680-8, 2012 Feb. Observational-Dx 54 patients (39 male, 15 female) To quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation with widely used indexes of CD activity. MPI and ß coefficients were significantly increased in the 36 patients with a CICDA indicative of active disease (P<.0001 for both), the 33 patients with a CDAI of at least 150 (P<.032 and P<.0074, respectively), and the 26 patients with an SES-CD of at least 1 (P<.0001 and P<.002, respectively). ROC analysis revealed accurate identification (compared with CICDA) of active CD with an MPI threshold of 24 video intensity (VI) (sensitivity, 97%; specificity, 83%) and a ß coefficient of 4.5 VI/sec (sensitivity, 86%; specificity, 83%). 2
41. Ma X, Li Y, Jia H, et al. Contrast-enhanced ultrasound in the diagnosis of patients suspected of having active Crohn's disease: meta-analysis. Ultrasound Med Biol. 41(3):659-68, 2015 Mar. Meta-analysis 8 studies This meta-analysis was aimed at assessing the performance of oral/microbubble contrast-enhanced ultrasound (CEUS) in the detection of active Crohn's disease (CD). A literature search of PubMed, Medline, the China National Knowledge Infrastructure and the Cochrane Library was conducted. A total of eight articles, which included 428 patients, were finally analyzed. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio andarea under the curve were calculated to examine the diagnostic accuracy of CEUS. The pooled sensitivity and specificity of CEUS for active CD were 93% (95% confidence interval: 89%–95%) and 87% (81%–91%), respectively. The summary diagnostic odds ratio was 80.35 (30.93–208.73), and the area under the curve was 0.9633. Good
42. Serafin Z, Bialecki M, Bialecka A, Sconfienza LM, Klopocka M. Contrast-enhanced Ultrasound for Detection of Crohn's Disease Activity: Systematic Review and Meta-analysis. [Review]. J Crohns Colitis. 10(3):354-62, 2016 Mar. Meta-analysis 8 studies (332 patients) To verify the diagnostic value of contrast-enhanced ultrasonography (CEUS) in detecting active crohn disease (aCD). Eight articles were included in the final analysis, with a total of 332 patients. There was no significant publication bias. Significant heterogeneity was found regarding CEUS methodology and sonographic definitions of aCD. In a bivariate analysis, pooled sensitivity was 0.94 (95% CI 0.87–0.97) and pooled specificity was 0.79 (95% CI 0.67–0.88). Spearman correlation statistics presented no significant diagnostic threshold effect (r = 0.12, p > 0.9). Subgroup analysis showed that relative intestine wall enhancement had the highest diagnostic value (area under the curve 94%), while the presence of enhancement and analysis of the slope were less useful (area under the curve 91 and 90%, respectively). Good
43. Medellin-Kowalewski A, Wilkens R, Wilson A, Ruan J, Wilson SR. Quantitative Contrast-Enhanced Ultrasound Parameters in Crohn Disease: Their Role in Disease Activity Determination With Ultrasound. AJR Am J Roentgenol. 206(1):64-73, 2016 Jan. Observational-Dx 127 patients To examine the association between contrast-enhanced ultrasound (CEUS) parameters and established gray-scale ultrasound with color Doppler imaging (CDI) for the determination of disease activity in patients with Crohn disease. Ninety-six (76%) studies were concordant, 19 of which showed severe disease, and 31 (24%) studies were indeterminate. Kappa analyses revealed good interobserver agreement on grades for CDI (? = 0.76) and ultrasound (? = 0.80) assessments. PE values on CEUS and wall thickness showed good association with the Spearman rank correlation coefficient for the entire population (? = 0.62, p < 0.01) and for the concordant group (? = 0.70, p < 0.01). Multiclass ROC analyses of the concordant group using wall thickness alone as the reference standard showed cutoff points of 18.2 dB for differentiating mild versus moderate activity (sensitivity, 89.0% and specificity, 87.0%) and 23.0 dB for differentiating moderate versus severe (sensitivity, 90% and specificity, 86.8%). Almost identical cutoff points were observed when using ultrasound global assessment as the reference standard: using 18.2 dB to differentiate mild versus moderate activity yielded sensitivity of 89.2% and specificity of 90.9% and using 22.9 dB to differentiate moderate versus severe activity yielded sensitivity of 89.5% and specificity of 83.1%. 2
44. Chen YJ, Mao R, Li XH, et al. Real-Time Shear Wave Ultrasound Elastography Differentiates Fibrotic from Inflammatory Strictures in Patients with Crohn's Disease. Inflamm Bowel Dis. 24(10):2183-2190, 2018 09 15. Observational-Dx 35 patients To evaluate the role of shear-wave elastography (SWE) for the characterization of intestinal fibrosis compared with conventional bowel ultrasound, and the capability of SWE in differentiating fibrotic from inflammatory strictures in patients with crohn disease (CD) using surgical histopathology as the reference standard. Thirty-five patients were enrolled. The mean SWE value of stenotic bowel wall was significantly higher in severe fibrosis (23.0 ± 6.3 Kpa) than that in moderate (17.4 ± 3.8 Kpa) and mild fibrosis (14.4 ± 2.1 Kpa)(P = 0.008). Using 22.55 KPa as the cutoff value in discriminating between mild/moderate and severe fibrosis, the sensitivity and specificity was 69.6 % and 91.7% with an area under the curve (AUC) of 0.822 (P = 0.002). However, no significant difference regarding mean SWE existed among different grades of inflammation. The sensitivity and specificity of bowel vascularization score on conventional ultrasound in differentiating severe inflammation from mild/moderate was 87.5 % and 57.9% with AUC of 0.811 (P = 0.002). Combining SWE and conventional ultrasound (bowel vascularization score), we propose a bowel ultrasound classification of intestinal strictures. A moderate agreement between ultrasound and pathological classification was observed (? = 0.536, P<0.001). 2
45. Stathaki MI, Koukouraki SI, Karkavitsas NS, Koutroubakis IE. Role of scintigraphy in inflammatory bowel disease. World J Gastroenterol. 2009;15(22):2693-2700. Review/Other-Dx N/A To review the current data and future prospects on the role of scintigraphy in diagnosis and evaluation of disease activity in patients with IBD. Although nuclear medicine in IBD has no primary role in the diagnosis, it might be considered when colonoscopy is not completed successfully or other imaging modalities are negative. However, its contribution to the assessment of disease extent and activity, monitoring treatment response, and differentiating between active CD and UC is well established. Tc-99m HMPAO WBC have gain widespread clinical use while Tc-99m (V) DMSA seems to provide an accurate scintigraphic variant and a complementary technique to colonoscopy for follow up and assessment of disease activity. 4
46. Chroustova D, El-Lababidi N, Trnka J, Cerna L, Lambert L. Scintigraphy with 99mTc-HMPAO labeled leukocytes is still an accurate and convenient tool to rule out suspected inflammatory bowel disease in children. Nucl Med Rev Cent East Eur. 22(2):69-73, 2019. Observational-Dx 85 children To assess the diagnostic accuracy of scintigraphy with 99mTechnetium Hexamethylpropyleneamine Oxime (99mTc-HMPAO) labeled leukocytes in children with suspected inflammatory bowel disease (IBD). Scintigraphy results corresponded with the final diagnosis in 78 (91%) patients resulting in a sensitivity of 89% (95%CI 72 to 98%), specificity of 91% (95% CI 82 to 98%), and accuracy of 91% (95% CI 83 to 96%). The interobserver agreement was 0.82 (95% CI 0.75 to 0.88) and the radiation dose estimate was 4.2 ± 1.5 mSv. In 28 children (25 positives and 3 negatives on scintigraphy), the diagnosis of IBD was established by endoscopy, histology, MR enterography, or fluoroscopy. Five positive findings on scintigraphy were not confirmed by other methods or during follow-up. 3
47. O'Regan K, O'Connor OJ, O'Neill SB, et al. Plain abdominal radiographs in patients with Crohn's disease: radiological findings and diagnostic value. Clin Radiol. 67(8):774-81, 2012 Aug. Observational-Dx 177 patients To determine the diagnostic yield and clinical value of plain film of the abdomen (PFA) in Crohn’s disease (CD) patients and to determine whether performance of PFA yields definitive diagnostic information or whether additional imaging examinations are required. A mean of 3.6 (range 1-22) PFAs was performed per patient during the study period. Almost 70% of films were normal (n = 449). SB abnormalities were detected in 21.8% (n = 140) PFAs; most commonly dilated loops (18.8%, n = 121) and mucosal oedema (5%, n = 32). Colonic abnormalities were present in 11.4% (n = 73); most commonly mucosal oedema (7.5%, n = 48) and dilated loops (5%, n = 32). Four cases of pneumoperitoneum were detected. There was no case of toxic megacolon. There was one case in which intra-abdominal abscess/collection was suspected and two cases of obstruction/ileus. Extracolonic findings (renal calculi, sacro-iliitis, etc.) were identified in 7.5% (n = 48). PFAs were followed by additional abdominal imaging within 5 days of PFA in 273/643 (42.5%) of cases. 3
48. Brodersen JB, Hess S. FDG-PET/CT in Inflammatory Bowel Disease: Is There a Future? PET Clin 2020;15:153-62. Review/Other-Dx N/A To review the role of fluorodeoxyglucose (FDG)-PET/computed tomography (CT) in inflammatory bowel disease. No results stated in the abstract. 4
49. Lemberg DA, Issenman RM, Cawdron R, et al. Positron emission tomography in the investigation of pediatric inflammatory bowel disease. Inflamm Bowel Dis 2005;11:733-8. Observational-Dx 65 children The aim of this study was to assess the value of PET (Positron emission tomography) in identifying active intestinal inflammation compared with conventional endoscopic and radiologic studies, including small bowel follow-through and colonoscopy. PET correctly identified active inflammatory disease in 80% of children with IBD (81.5% with Crohn's disease; 76.4% with ulcerative colitis) and correctly showed no evidence of inflammation in children with recurrent abdominal pain. Gluorine-18-fluoro-deoxyglucose accumulated at sites that corresponded with active disease at colonoscopy in 83.8% of patients and with small bowel follow-through with pneumocolon 75.0% of the time. 2
50. Ordas I, Rimola J, Rodriguez S, et al. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn's disease. Gastroenterology. 146(2):374-82.e1, 2014 Feb. Observational-Dx 48 patients To assess the accuracy of magnetic resonance enterography (MRE) in monitoring response to therapy in patients with Crohn's disease (CD) using ileocolonoscopy as a reference standard. MRE determined ulcer healing with 90% accuracy and endoscopic remission with 83% accuracy. The mean CDEIS and MaRIA scores significantly changed at week 12 in segments with ulcer healing, based on endoscopic examination (CDEIS: 21.28 +/- 9.10 at baseline vs 2.73 +/- 4.12 at 12 weeks; P < .001 and MaRIA: 148 patients 8.86 +/- 9.50 at baseline vs 8.73 +/- 5.88 at 12 weeks; P < .001). The MaRIA score accurately detected changes in lesion severity (Guyatt score: 1.2 and standardized effect size: 1.07). MRE was as reliable as endoscopy in assessing healing; no significant changes in CDEIS or MaRIA scores were observed in segments with persistent ulcers, based on endoscopic examination (CDEIS: 26.43 +/- 9.06 at baseline vs 20.77 +/- 9.13 at 12 weeks; P = .18 and MaRIA: 22.13 +/- 8.42 at baseline vs 20.77 +/- 9.17 at 12 weeks; P = .42). The magnitude of change in CDEIS scores correlated with those in MaRIA scores (r = 0.51; P < .001). 3
51. Moy MP, Kaplan JL, Moran CJ, Winter HS, Gee MS. MR Enterographic Findings as Biomarkers of Mucosal Healing in Young Patients With Crohn Disease. AJR Am J Roentgenol 2016;207:896-902. Observational-Dx 30 patients (15 female; 15 male) To investigate the magnetic resonance (MR) enterographic findings that best correlate with mucosal healing assessed with ileocolonoscopy. A total of 30 patients (15 female patients, 15 male patients; age range, 8-24 years; mean, 17.2 ± 3.2 years) with pediatric-onset Crohn disease were examined. The average time between MR enterography and the second ileocolonoscopic examination was 12.7 ± 7.9 days. A total of 202 bowel segments from the terminal ileum to rectum were evaluated in the 60 ileocolonoscopic examinations. Forty-four bowel segments exhibited mucosal healing, and 37 segments exhibited persistent inflammation. At imaging, the MR index of activity score in mucosal healing segments was 6.6 ± 3.4, compared with 13.7 ± 9.7 in segments without mucosal healing (p = 0.0001). The average bowel wall thickness in healing segments was 2.7 ± 0.9 mm compared with 4.7 ± 3.1 mm in persistently inflamed segments (p = 0.0004). An MR index of activity score less than 8 had the highest accuracy for mucosal healing (accuracy, 74%; sensitivity, 84%; specificity, 62%; p < 0.0001). Mucosal hyperenhancement (72%, 98%, 41%), mesenteric hypervascularity (72%, 98%, 41%), bowel wall edema (72%, 93%, 46%), and bowel wall thickness less than 4 mm (72%, 84%, 57%) were also strongly associated with mucosal healing (p < 0.0003). 2
52. Chu KF, Moran CJ, Wu K, et al. Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease. J Magn Reson Imaging 2019;50:1955-63. Observational-Dx 37 patients To determine whether MR enterography (MRE) imaging features are associated with clinical recurrence. Of 35 MREs identified, seven cases demonstrated clinical recurrence at 6 months (20%); 28 cases remained in remission (80%). Imaging features of active disease were present in 86% of patients with recurrence compared to 29% of patients in remission (P = 0.01). Wall thickening, T2 -weighted hyperintensity, hyperenhancement, and diffusion restriction were significantly associated with recurrence. Multivariate regression analysis determined diffusion restriction to be the best predictor of recurrence within 6 months (P = 0.001, area under the curve 0.786). 2
53. Barkmeier DT, Dillman JR, Al-Hawary M, et al. MR enterography-histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis?. Pediatric Radiology. 46(4):498-507, 2016 Apr. Observational-Dx 20 children To retrospectively correlate the magnetic resonance imaging (MRI) features of surgically resected small-bowel strictures in pediatric Crohn disease with histological inflammation and fibrosis scoring. There was significant positive correlation between histological bowel wall fibrosis and inflammation in resected strictures (? = 0.55; P = 0.01). Confluent transmural histological fibrosis was associated with pre-stricture upstream small-bowel dilatation >3 cm at univariate (odds ratio [OR] = 51.7; 95% confidence interval [CI]: 7.6- > 999.9; P = 0.0002) and multivariate (OR = 43.4; 95% CI: 6.1- > 999.9; P = 0.0006, adjusted for age) analysis. The degree of bowel wall T2-weighted signal intensity failed to correlate with histological bowel wall fibrosis or inflammation (P-values >0.05). There were significant negative correlations between histological fibrosis score and patient age at resection (? = -0.48, P = 0.03), and time from diagnosis to surgery (? = -0.73, P = 0.0002). 2
54. Tabari A, Kilcoyne A, Jeck WR, Mino-Kenudson M, Gee MS. Texture Analysis of Magnetic Resonance Enterography Contrast Enhancement Can Detect Fibrosis in Crohn Disease Strictures. J Pediatr Gastroenterol Nutr 2019;69:533-38. Observational-Dx 25 patients The aim of the study was to investigate if texture analysis of contrast-enhanced magnetic resonance enterography (MRE) images can determine Crohn disease (CD) stricture histologic type. Sixty-four bowel segments from 25 patients (mean age 16 ± 2 years) with imaging-histologic correlation were included. Of note, all strictures included had undergone surgical resection with MRE imaging available within 30 days. The histologic distribution of these bowel segments included 9 segments that showed active inflammation without fibrosis, 23 segments that showed only fibrosis, and 32 mixed segments with concomitant active inflammation and fibrosis. Bivariate regression analysis demonstrated that skewness, standard deviation, entropy, and mean texture analysis features are independently associated with stricture fibrosis. Stepwise logistic regression showed that the combination of mean, skewness, and entropy texture predicted stricture fibrosis with a goodness-of-fit value of 0.995. A combination of threshold values for these 3 texture analysis parameters was able to correctly classify 100% of the strictures in the study cohort for presence (55/55) and absence (9/9) of fibrosis. 2
55. Puylaert CA, Tielbeek JA, Bipat S, Stoker J. Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis. [Review]. Eur Radiol. 25(11):3295-313, 2015 Nov. Meta-analysis 19 studies To systematically review and compare the accuracy of computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US) and scintigraphy and positron emission tomography–computed tomography (PET-CT) in grading Crohn’s disease activity on a per-patient or per-segment basis as compared to endoscopy, biopsies or intraoperative findings by performing a meta-analysis. Furthermore, we aimed to investigate the degree of over- and under-grading for these imaging techniques. Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86% (95% CI: 75-93%), 84% (95% CI: 67-93%), 44% (95% CI: 28-61%) and 40% (95% CI: 16-70%), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87% (95% CI: 77-93%) and 86% (95% CI: 80-91%), respectively. MRI and US showed grading accuracies of 67-82% and 56-75%, respectively. Good
56. Dillman JR, Smith EA, Sanchez R, et al. Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease. Pediatr Radiol. 46(4):490-7, 2016 Apr. Observational-Dx 29 children To prospectively assess ultrasound (US)-US and US-MR enterography (MRE) inter-radiologist agreement in pediatric small bowel Crohn disease. Ultrasound-US agreement was moderate for involved length (ICC: 0.41 [0.35-0.49]); substantial for maximumbowelwall thickness (ICC: 0.67 [0.64-0.70]); moderate for bowel wall Doppler signal (ICC: 0.53 [0.48-0.59]); slight for mesentericDoppler signal (ICC: 0.25 [0.18-0.42]), and moderate to almost perfect for stricture (?: 0.54), penetrating disease (?:0.80), and abscess (?: 0.96). US-MRE agreement was moderate for involved length (ICC: 0.42 [0.37-0.49]); substantial formaximum bowel wall thickness (ICC: 0.66 [0.65-0.69]), and substantial to almost perfect for stricture (?: 0.61), penetratingdisease (?: 0.72) and abscess (?: 0.88). 2
57. Siddiqui MR, Ashrafian H, Tozer P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. [Review]. Dis Colon Rectum. 55(5):576-85, 2012 May. Meta-analysis Four studies To present a systematic review of published literature comparing endoanal ultrasound with magnetic resonance imaging (MRI) for the assessment of idiopathic and Crohn's perianal fistulas. The combined sensitivity and specificity of magnetic resonance for fistula detection were 0.87 (95% CI: 0.63-0.96) and 0.69 (95% CI: 0.51-0.82). There was a high degree of heterogeneity between studies reporting on MRI sensitivity (df = 3, I = 93%). This compares to a sensitivity and specificity for endoanal ultrasound of 0.87 (95% CI: 0.70-0.95) and 0.43 (95% CI: 0.21-0.69). There was a high degree of heterogeneity between studies reporting on endoanal ultrasound sensitivity (df = 3, I = 92%). Good
58. AlSabban Z, Carman N, Moineddin R, et al. Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?. J Magn Reson Imaging. 47(6):1638-1645, 2018 06. Observational-Dx 77 patients (27 females, 50 males) To determine if magnetic resonance enterography (MRE) can accurately detect perianal disease (PAD) in pediatric inflammatory bowel disease (PIBD), distinguishing perianal fistulae (PAF) from perianal abscesses (PAA), referenced against P-MRI. P-MRI and MRE were paired, detecting PAD in 73 patients, PAF in 63, and PAA in 31 P-MRI. MRE sensitivities, specificities, PPV, and NPV were: PAD 82%, 100%, 100%, 23%; PAF 74%, 71%, 92%, 38%; PAA 51%, 85%, 69%, 72%; clinical 82%, 22%, 37%, 69%; clinical P-MRI 96%, 8%, 37%, 80%. MRE interreader agreement for PAD was moderate (kappa = 0.51 [0.29-0.73]), fair for PAF and PAA. 3
59. Kulkarni S, Gomara R, Reeves-Garcia J, Hernandez E, Restrepo R. MRI-based score helps in assessing the severity and in follow-up of pediatric patients with perianal Crohn disease. J Pediatr Gastroenterol Nutr. 58(2):252-7, 2014 Feb. Observational-Dx 31 patients To study whether the various magnetic resonance imaging (MRI)-based radiologic parameters and score can help in staging and follow-up of patients with perianal fistulizing Crohn disease (PfCD). Of the radiologic parameters, the number of fistulas, the complexity of fistulas, and the number of abscesses were significantly lower in the asymptomatic group compared with the mild-to-moderate and severe disease groups. The Van Assche MRI-based score was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.01) and the severe disease group (P = 0.002). The percentage increase in fistula activity after gadolinium administration was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.026) and severe disease (P = 0.019) groups. The MRI-based scores were significantly higher in the MRI examinations performed at diagnosis compared with those that were performed while the patients were receiving the treatment (P = 0.017). 3
60. Lee EH, Yang HR, Kim JY. Comparison of Transperianal Ultrasound With Colonoscopy and Magnetic Resonance Imaging in Perianal Crohn Disease. J Pediatr Gastroenterol Nutr. 66(4):614-619, 2018 04. Observational-Dx 38 children and adolescents To assess the accuracy of transperianal ultrasound (TPUS) and colonoscopic examination, compared with MRI, in pediatric patients with perianal CD (PACD). Fifty-nine fistulae (26 superficial, 23 intersphincteric, 10 transsphincteric) and 16 abscesses were detected using MRI. Fifty-nine fistulae and 10 abscesses were detected using TPUS. Forty-five fistulae (sensitivity 76.3%, positive predictive value [PPV] 84.2%, and kappa value 0.296] and 9 abscesses (sensitivity 56.3%, PPV 90.0%, and kappa value 0.624) on TPUS corresponded with MRI findings. Forty-six fistulae and fifteen abscesses were detected using colonoscopy. Forty fistulae (sensitivity 67.8%, PPV 89.9%, and kappa value 0.369) and 7 abscesses (sensitivity 43.8%, PPV 48.8%, and kappa value 0.304) on colonoscopy corresponded with MRI findings. With respect to abscess, agreement between TPUS and MRI was superior to that between colonoscopy and MRI (Spearman rho 0.651 vs 0.304, P = 0.007). 2
61. Maconi G, Greco MT, Asthana AK. Transperineal Ultrasound for Perianal Fistulas and Abscesses - A Systematic Review and Meta-Analysis. [Review]. Ultraschall Med. 38(3):265-272, 2017 Jun. Review/Other-Dx 12 studies To systematically review its accuracy for detecting and classifying perianal fistulae and abscesses. We included 12 studies (565 patients). Overall, the methodological quality of the studies was suboptimal. 3 studies were retrospective and 4 showed significant risks of bias in the application of the reference standard. The sensitivity of TPUS in detecting perianal fistulae on a per-lesion basis was 98 % (95 % CI 96 - 100 %) and the PPV was 95 % (95 % CI 90 - 98 %). The detection of internal openings had a sensitivity of 91 % (95 % CI 84 - 97 %) with a PPV of 87 % (95 % CI 76 - 95 %). The classification of fistulae yielded a sensitivity of 92 % (95 % CI 85 - 97 %) and a PPV of 92 % (95 % CI 83 - 98 %). TPUS had a sensitivity of 86 % (95 % CI 67 - 99 %) and PPV of 90 % (95 % CI 76 - 99 %) in the detection of perianal abscesses. 4
62. Bor R, Farkas K, Balint A, et al. Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease. J Ultrasound Med. 35(11):2367-2372, 2016 Nov. Observational-Dx 23 patients To prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease. Twenty-three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%). 2
63. Maconi G, Tonolini M, Monteleone M, et al. Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohn's disease. Inflamm Bowel Dis. 19(13):2737-43, 2013 Dec. Observational-Dx 59 Patients To assess the accuracy of transperineal ultrasound (TPUS), in comparison with magnetic resonance imaging (MRI), in classifying perianal Crohn's disease (CD) according to Parks' classification and the American Gastroenterological Association criteria. Forty-six patients showed 64 fistulae (9 intersphincteric, 34 transsphincteric, 2 suprasphincteric, 9 extrasphincteric, and 10 anovaginal) and 23 abscesses were also found. Fifty-one of 54 perianal fistulae (per-lesion sensitivity: 94.4%) and 9 of 10 anovaginal fistulae (sensitivity: 90.0%) were detected and 58 were correctly classified by TPUS (sensitivity: 90.6%; positive predictive value: 93.4%). Overall, TPUS correctly detected and classified the fistulae in 89% of patients and the agreement for classifying perianal fistulae between TPUS and MRI was excellent (K value: 0.783). In contrast, 11 of 23 abscesses were correctly diagnosed by TPUS (sensitivity: 47.8%); although 14 abscesses were diagnosed by TPUS, only 11 were confirmed by MRI (positive predictive value: 78.6%). Overall, TPUS correctly detected and classified fistulae and associated abscesses in 67.3% of patients. Agreement between MRI and TPUS in discriminating simple (15) and complex (29) perianal disease was fairly good (K value: 0.57). 3
64. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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