35 Imaging of Inflammatory Bowel Disease in Children

Children with clinically suspected IBD should have both upper and lower endoscopies as part of the initial workup (strong evidence). Fluoroscopic small bowel follow-through (SBFT) studies are typically performed as part of the initial diagnosis (limited evidence). Wireless capsule endoscopy (WCE) is a safe, moderately sensitive test for the detection of small bowel inflammatory changes and should be utilized in patients without small bowel obstruction and when other diagnostic small bowel exams are negative. However, the specificity and positive predictive value need to be further established (limited evidence). MRI is superior to CT and is the preferred initial diagnostic and follow-up imaging exam of perirectal and perianal disease in Crohn’s disease (CD) patients (moderate–strong evidence). About 70–80% of CD patients and 30–40% of UC patients will require surgery for disease refractory to medical therapy, or severe disease with complications, or risk of malignancy (UC) (moderate evidence). Repeat imaging with SBFT and CT results in significant ionizing radiation exposure and risk of later cancer induction so that alternative imaging methods, MRI and US, should be used (limited evidence).