Use of small bowel imaging for the diagnosis and staging of Crohn's disease--a survey of current UK practice.

OBJECTIVES This study used a postal survey to assess the current use of small bowel imaging investigations for Crohn's disease within National Health Service (NHS) radiological practice and to gauge gastroenterological referral patterns. METHODS Similar questionnaires were posted to departments of radiology (n = 240) and gastroenterology (n = 254) identified, by the databases of the Royal College of Radiologists and British Society of Gastroenterologists. Questionnaires enquired about the use of small bowel imaging in the assessment of Crohn's disease. In particular, questionnaires described clinical scenarios including first diagnosis, disease staging and assessment of suspected extraluminal complications, obstruction and disease flare. The data were stratified according to patient age. RESULTS 63 (27%) departments of radiology (20 in teaching hospitals and 43 in district general hospitals (DGHs)) and 73 (29%) departments of gastroenterology replied. These departments were in 119 institutions. Of the 63 departments of radiology, 55 (90%) routinely performed barium follow-though (BaFT), 50 (80%) CT, 29 (46%) small bowel ultrasound (SbUS) and 24 (38%) small bowel MRI. BaFT was the most commonly used investigation across all age groups and indications. SbUS was used mostly for patients younger than 40 years of age with low index of clinical suspicion for Crohn's disease (in 44% of radiology departments (28/63)). MRI was most frequently used in patients under 20 years of age for staging new disease (in 27% of radiology departments (17/63)) or in whom obstruction was suspected (in 29% of radiology departments (18/63)). CT was preferred for suspected extraluminal complications or obstruction (in 73% (46/63) and 46% (29/63) of radiology departments, respectively). Gastroenterological referrals largely concurred with the imaging modalities chosen by radiologists, although gastroenterologists were less likely to request SbUS and MRI. CONCLUSION BaFT remains the mainstay investigation for luminal small bowel Crohn's disease, with CT dominating for suspected extraluminal complications. There has been only moderate dissemination of the use of MRI and SbUS.

[1]  Laurent Beaugerie,et al.  The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. , 2006, Journal of Crohn's & colitis.

[2]  B. Avidan,et al.  Multislice CT compared to small bowel follow-through in the evaluation of patients with Crohn disease. , 2008, Clinical imaging.

[3]  M. Maher,et al.  Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation , 2008, Gut.

[4]  Roelof J Bennink,et al.  Magnetic resonance imaging in Crohn's disease , 2008 .

[5]  D. Frush,et al.  Radiation doses from small-bowel follow-through and abdomen/pelvis MDCT in pediatric Crohn disease , 2008, Pediatric Radiology.

[6]  Diego R. Martín,et al.  Utility of magnetic resonance imaging in small bowel Crohn's disease. , 2007, Gastroenterology.

[7]  B. Sands.  Inflammatory bowel disease: past, present, and future , 2007, Journal of Gastroenterology.

[8]  G. Masselli,et al.  Assessment of Crohn’s disease in the small bowel: prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis , 2006, European Radiology.

[9]  D. Maglinte,et al.  Advances in alimentary tract imaging. , 2006, World journal of gastroenterology.

[10]  B F Warren,et al.  European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis , 2006, Gut.

[11]  Amy K Hara,et al.  Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. , 2006, Radiology.

[12]  L. Ryner,et al.  A Prospective Comparison Study of MRI versus Small Bowel Follow-Through in Recurrent Crohn's Disease , 2005, The American Journal of Gastroenterology.

[13]  R. Caprilli,et al.  Small Intestine Contrast Ultrasonography: An Alternative to Radiology in the Assessment of Small Bowel Disease , 2005, Inflammatory bowel diseases.

[14]  A. Bremner,et al.  Ultrasound scanning may reduce the need for barium radiology in the assessment of small‐bowel Crohn's disease , 2004, Acta paediatrica.

[15]  H. D'costa.  Observer variation in the detection of colorectal neoplasia on double-contrast barium enema: implications for colorectal cancer screening and training. , 2004, Clinical radiology.

[16]  S. Gallus,et al.  Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel , 2003, Alimentary pharmacology & therapeutics.

[17]  K. Jacobson,et al.  Comparison of multidetector CT and barium studies of the small bowel: inflammatory bowel disease in children. , 2003, AJR. American journal of roentgenology.

[18]  D. Choi,et al.  Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity. , 2003, Clinical radiology.

[19]  M. Mínguez,et al.  Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops , 2001, European Radiology.

[20]  K. Karlinger,et al.  Ultrasound in Crohn's disease of the small bowel. , 2000, European journal of radiology.

[21]  S. Hollerbach,et al.  The accuracy of abdominal ultrasound in the assessment of bowel disorders. , 1998, Scandinavian journal of gastroenterology.

[22]  G. Lux,et al.  Ultrasonography as a primary diagnostic tool in patients with inflammatory disease and tumors of the small intestine and large bowel , 1994, Journal of clinical ultrasound : JCU.

[23]  D. Martin,et al.  Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn's disease or recurrence: a prospective study. , 1993, Clinical radiology.