Ultrasound and magnetic resonance enterography in diagnosis of Crohn's disease in children

Introduction: Crohn's disease is a chronic inflammatory bowel disease, which is characterized by remitting and relapsing episodes, and commonly affects younger than 30. Magnetic resonance enterography (MRE) and ultrasound (US) are taking the leading role over colonoscopy and computed tomography (CT) in diagnostics, initial estimation of Crohn's disease and monitoring of activity, detection and evaluation of complications. Aim: To examine sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) of US and MRE in diagnosis of Crohn's disease. Also, to examine overall diagnostic value of MRE comparing morphological and functional parameters with endoscopic findings. Material and methods: 40 patients were observed from the end of year 2009 to the end of 2016. Diagnosed patients with clinical and laboratory findings were sent for US and MRE examination. US evaluated wall thickness, mesenteric fibrofatty proliferation and enlargement of mesenteric lymph nodes. Beside this, MRE also evaluated bowel wall enhancement and layered enhancement pattern. Results: Overall diagnostic value of morphological and functional parameters on the MRE has a SE of 58.3% and SP of 100% if we want to confirm the diagnosis, and SE 87.5% and SP of 80% if we want to exclude the diagnosis. There was statistically significant correlation between the increased wall thickness and the accumulation of fat in the mesentery on MRE, and the gold standard (colonoscopy/histopathology, clinical presentation and laboratory findings).Correlation between results on US and MRE shows statistical significance in diagnostics of Crohn's disease in ileum, terminal ileum, Bauchini valve and cecum, ascendant colon in children. It showed high specificity (SP) for both diagnostic procedures in almost all segments (maximum value 94,7%). Sensitivity (SE) varied from 0 to 83,3% in different bowel segments. Conclusion: Our study showed that it is reliable to use MRE and US to exclude those who don't have Crohn's disease. Also, combination of morphological and functional parameters on MRE could be used in confirming and monitoring Crohn's disease.