SICUS, MRE, CE: Effective Imaging Techniques for Pediatric Crohn's Disease

Researchers based at the Sapienza University of Rome, Italy, have revealed potentially favorable results from 3 imaging methods for pediatric patients with Crohn’s disease: magnetic resonance enterography (MRE), small-intestine contrast US (SICUS), and capsule endoscopy (CE) in diagnosing pediatric Crohn’s disease (CD).

Led by Salvatore Cucciara, the Pediatric Gastroenterology and Liver unit research team conducted a prospective comparison blinded study with 25 patients recruited from a tertiary center for pediatric inflammatory bowel disease (IBD). Their primary goal was to assess sensitivity, specificity, and accuracy of the 3 promising imaging methods.

In a study recently published in the journal Gastrointestinal Endoscopy, the research team compared each imaging method with a standard method used for upper small-bowel imaging and with ileocolonoscopy for the terminal ileum.

Each study participant had ileocolonoscopy, MRE, SICUS, and CE for a 7-day-period, with examination separated into 3 sections: jejunum, proximal and mid ileum, and terminal ileum.

The results showed that the sensitivity of SICUS and CE was 92% in the jejunum, higher than MRE (75%), and the specificity of CE was reported lower than that of MRE. However, in the proximal and mid ileum, results showed that MRE and CE had higher sensitivity (100%) than SICUS (80%), but CE was less specific. Lastly, in the terminal ileum, results revealed that SICUS and MRE were more sensitive than CE (94% versus 81%, respectively), however CE was more specific.

As such, the experts concluded that all SICUS, MRE, and CE were useful selections for imaging the small bowel. Furthermore, they suggested that a complete assessment of the small bowel integrating these different methods could potentially be beneficial in this particular population of pediatric CD.

“Our study supports the use of radiation-free and well-tolerated imaging modalities as a means of first-line investigation in children with suspected or already diagnosed CD. The combination of SICUS and [C-reactive protein], given its high sensitivity, specificity, low-cost, and non-invasiveness, could be suggested as a first-line diagnostic approach in suspected [small-bowel] CD. MRE and CE can be subsequently used in patients with inconclusive workups, based on the local expertise and availability,” concluded the authors.