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MRI enterography for assessment of small bowel involvement in pediatric Crohn's

The latest issue of the Alimentary Pharmacology & Therapeutics investigates MRI enterography for assessment of small bowel involvement in pediatric Crohn's disease.

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Barium meal enteroclysis is the recommended imaging technique for small bowel inaccessible by ileo-colonoscopy when diagnosing pediatric-onset inflammatory bowel disease, but it has poor sensitivity and involves ionising radiation.

MRI enterography is an alternative methodology.
 
Dr Andrew Barclay and colleagues from the United Kingdom critically appraised the published evidence on MRI enterography in the assessment of Pediatric inflammatory bowel disease by systematic review.
 
Review of all English language data reporting MRI enterography for the investigation of patients less than 18 years with known or suspected IBD.

Primary searches of Medline, Cinahl and Pubmed were performed using keyword and MeSH terms, including IBD, magnetic resonance imaging, small bowel imaging, EMBASE was then searched.

The team reported that 2 authors independently assessed the quality of studies using the quality assessment of diagnostic accuracy studies tool.

The pooled sensitivity for MRI enterography detection of active terminal ileal Crohn's is 84%
Alimentary Pharmacology & Therapeutics

Searches yielded 930,035 hits, combination word searches limited to 1983 titles.

The team reviewed 52 studies were fully, and 41 were excluded due to lack of pediatric data.

The research team included 11 studies of 496 children.

All studies used endoscopy as the reference test.

The research team found that 10 out of 496 patients required jejunal intubation for bowel preparation.

Meta-analysis of 6 comparable studies gave a pooled sensitivity and specificity for MRI enterography detection of active terminal ileal Crohn's disease of 84% and 97%, respectively.

Studies displayed heterogeneity in bowel preparation, scanning technique, reporting methodology and timing of ileo-colonoscopy in relation to MRI enterography.

In 3 studies comparing barium meal enteroclysis, MRI enterography had greater sensitivity and specificity.
 
Dr Barclay's team concludes, "MRI enterography is a sensitive and specific tool for diagnosis in paediatric inflammatory bowel disease."

"Technical considerations require refinement and standardization."

"However, MRI enterography has no radiation. Current data suggest that MRI enterography should supersede barium meal enteroclysis as the small bowel imaging technique in centers with appropriate expertise."

Aliment Pharmacol Ther 2013: 37(12): 1121-1131
24 May 2013

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