Moreover, the involvement of the jejunum alone is uncommon and it

Moreover, the involvement of the jejunum alone is uncommon and it is more difficult to investigate because of its tendency to stay non distended[3]. The clinical importance of the SB CD phenotype is the impact that a diffuse SB disease is expected to have on a child��s growth and development. Moreover, patients with SB CD are more likely to experience complications, including intestinal obstruction and less commonly fistulization[4,5]. Thus, objective evaluation of the SB is essential in differentiating CD from other enteropathies and in directing the management of the patients with inflammatory bowel disease (IBD)[6,7]. The morphological evaluation of the SB, useful in the diagnosis and management of CD, has long been made only with conventional radiology.

In the last decade there has been a progressive improvement of cross-sectional imaging [ultrasonography (US), computed tomography (CT), and magnetic resonance (MR)] that has significantly changed the way to diagnose and treat the patients[8,9]. Indeed, their accuracy in detecting mucosal alterations and transmural and perienteric inflammations, has led to a new disease staging, a detection of asymptomatic disease and a better assessment of response to therapy[10]. For these reasons modern cross-sectional imaging have replaced the traditional fluoroscopy-based for visualization of the SB. In the ��Porto criteria�� small-bowel follow-through (SBFT) was the recommended imaging modality in children[11]. However, concerns about the proven increased risk of high radiation exposure in pediatric patients mandates the use of alternative techniques when possible[12-14].

In the European Crohn��s and Colitis Organization (ECCO) guidelines[14] it is stated that MR and CT enterography or enteroclysis are the imaging modalities with the highest diagnostic accuracy. Moreover in the pediatric section of the ECCO guidelines[15,16] dynamic contrast-enhanced MRI is considered the best imaging to show most of the CD��s lesions without exposure Brefeldin_A to ionizing radiation. In the same way the Appropriateness Criteria of the American College of Radiology[17] point out that, in the pediatric patients, MR enterography may have sensitivity and specificity similar to CT enterography and avoids radiation risks. Ultimately the same accuracy, the choice of examination depends on several variables, such as institutional preferences and resources (US, CT, or MR scan), age and compliance of the patient, the eventually acute presentation, and finally radiologist expertise. In this article we discuss all the methods commonly used for imaging the small bowel in paediatric patients with Crohn��s disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

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