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Optimal Assessment of Paediatric IBD With MRI and Barium Follow-through

Giles, Edward*; Hanci, Ozan*; McLean, Alison; Power, Niall; Cole, Angela*; Croft, Nicholas M.*; McDonald, Kirsteen; Chippington, Sam; Naik, Sandhia*

Journal of Pediatric Gastroenterology and Nutrition: June 2012 - Volume 54 - Issue 6 - p 758–762
doi: 10.1097/MPG.0b013e3182460111
Original Articles: Gastroenterology

Objectives: The present UK criterion standard for assessing children with suspected inflammatory bowel disease (IBD) is upper endoscopy, ileocolonoscopy, and barium follow-through (BaFT). Significant doses of radiation, unpalatable contrast, and volume intolerance are involved with BaFT. Practice in investigating Crohn disease (CD) is changing with the increasing use of magnetic resonance imaging (MRI). The aim of the present study was to compare BaFT and a new abdominal MRI protocol in a paediatric IBD population.

Methods: All consecutive patients with a new diagnosis of IBD or requiring reassessment from September 2008 to December 2010 were investigated with both abdominal MRI and BaFT in accordance with a specific local paediatric IBD protocol. The studies were reported by nonblinded radiologists with an interest in gastrointestinal imaging. The reports were compared in conjunction with case note review.

Results: 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.

Conclusions: This is the largest series of small bowel MRI in a paediatric population. MRI reports were at least equivalent to BaFT. MRI had higher sensitivity and, particularly, specificity in detecting terminal ileal pathology. These findings suggest that MRI should become the criterion standard investigation in children with IBD in centres with appropriate expertise, with zero radiation exposure being highly advantageous.

*Department of Paediatric Gastroenterology, Barts and The London Children's Hospital

Diagnostic Imaging, the Royal London Hospital, London, United Kingdom.

Address correspondence and reprint requests to Edward Giles, MBBS, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, 3 Newark St, London E1 2AT, UK (e-mail:

Received 10 October, 2011

Accepted 9 December, 2011

E.G. is funded by the Crohn's and Colitis in Children Research Association.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN