European Society of Paediatric Radiology abdominal imaging task force: statement on imaging in very early onset inflammatory bowel disease

  • Tom A. WatsonEmail author
  • Philippe Petit
  • Thomas A. Augdal
  • E. Fred Avni
  • Costanza Bruno
  • M. Beatrice Damasio
  • Kassa Darge
  • Damjana Kjucevsek
  • Stéphanie Franchi-Abella
  • Donald Ibe
  • Annemieke Littooij
  • Luisa Lobo
  • Hans J. Mentzel
  • Marcelo Napolitano
  • Aikaterini Ntoulia
  • Michael Riccabona
  • Samuel Stafrace
  • Magdalena Wozniak
  • Lil-Sofie Ording Müller


Very early onset inflammatory bowel disease (VEO-IBD) is defined as disease presenting before the age of 6. These children require a tailored imaging approach because conventional imaging studies can be difficult to perform at such a young age. Unlike inflammatory bowel disease in older children and adults, colonic disease predominates in VEO-IBD, and small-bowel disease is rare. Distinguishing Crohn disease from ulcerative colitis is challenging both clinically and on histology. Radiology offers the greatest utility for detecting small-bowel disease because it helps to distinguish the two main disease entities and guide clinical management. Small-bowel ultrasound is recommended as the first-line investigation because it requires relatively little preparation, is readily available and is generally well tolerated in young children. We present these recommendations, based on the current evidence for radiologic management in this group, and propose an imaging algorithm for investigating VEO-IBD.


Children Computed tomography Infant Inflammatory bowel disease Magnetic resonance imaging Ultrasound 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Uhlig HH, Schwerd T, Koletzko S et al (2014) The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology 147:990–1007CrossRefGoogle Scholar
  2. 2.
    Levine A, Koletzko S, Turner D et al (2014) ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 58:795–806Google Scholar
  3. 3.
    Okou DT, Kugathasan S (2014) Role of genetics in pediatric inflammatory bowel disease. Inflamm Bowel Dis 20:1878–1884CrossRefGoogle Scholar
  4. 4.
    Rosen M, Dhawan A, Saeed S (2015) Inflammatory bowel disease in children and adolescents. JAMA Pediatr 169:1053–1060CrossRefGoogle Scholar
  5. 5.
    Assa A, Amitai M, Greer ML et al (2017) Perianal pediatric Crohn disease is associated with a distinct phenotype and greater inflammatory burden. J Pediatr Gastroenterol Nutr 65:293–298CrossRefGoogle Scholar
  6. 6.
    Dore M, Triana Junco P, Sánchez Galán A et al (2018) Pitfalls in diagnosis of early-onset inflammatory bowel disease. Eur J Pediatr Surg 28:39–43CrossRefGoogle Scholar
  7. 7.
    Virta LJ, Ashorn M, Kolho KL (2013) Cow's milk allergy, asthma, and pediatric IBD. J Pediatr Gastroenterol Nutr 56:649–651CrossRefGoogle Scholar
  8. 8.
    Mollard BJ, Smith EA, Lai ME et al (2016) MR enterography under the age of 10 years: a single institutional experience. Pediatr Radiol 46:43–49CrossRefGoogle Scholar
  9. 9.
    Sadigh S, Chopra M, Sury MR et al (2017) Paediatric magnetic resonance enteroclysis under general anaesthesia — initial experience. Pediatr Radiol 47:877–883CrossRefGoogle Scholar
  10. 10.
    Courtier J, Cardenas A, Tan C et al (2015) Nonanesthesia magnetic resonance enterography in young children: feasibility, technique, and performance. J Pediatr Gastroenterol Nutr 60:754–761CrossRefGoogle Scholar
  11. 11.
    Ahmad TM, Greer ML, Walters TD et al (2016) Bowel sonography and MR enterography in children. AJR Am J Roentgenol 206:173–181CrossRefGoogle Scholar
  12. 12.
    Barber JL, Zambrano-Perez A, Olsen ØE et al (2018) Detecting inflammation in inflammatory bowel disease — how does ultrasound compare to magnetic resonance enterography using standardised scoring systems? Pediatr Radiol 48:843–851CrossRefGoogle Scholar
  13. 13.
    Ziech MLW, Hummel TZ, Smets AMJB et al (2014) Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatr Radiol 4:1370–1378CrossRefGoogle Scholar
  14. 14.
    Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79CrossRefGoogle Scholar
  15. 15.
    Taylor SA, Mallett S, Bhatnagar G et al (2018) Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 3:548–558CrossRefGoogle Scholar
  16. 16.
    Taylor SA, Avni F, Cronin CG et al (2017) The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol 27:2570–2582CrossRefGoogle Scholar
  17. 17.
    Elliott CL, Maclachlan J, Beal I (2018) Paediatric bowel ultrasound in inflammatory bowel disease. Eur J Radiol 108:21–27CrossRefGoogle Scholar
  18. 18.
    Riccabona M, Lobo ML, Augdal TA et al (2018) European Society of Paediatric Radiology abdominal imaging task force recommendations in paediatric uroradiology, part X: how to perform paediatric gastrointestinal ultrasonography, use gadolinium as a contrast agent in children, follow up paediatric test. Pediatr Radiol 48:1528–1536CrossRefGoogle Scholar
  19. 19.
    Darge K, Anupindi S, Keener H, Rompel O (2010) Ultrasound of the bowel in children: how we do it. Pediatr Radiol 40:528–536CrossRefGoogle Scholar
  20. 20.
    Maconi G, Nylund K, Ripolles T et al (2018) EFSUMB recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall Med 39:304–317CrossRefGoogle Scholar
  21. 21.
    Dillman JR, Rubin JM, Johnson LA et al (2017) Can contrast-enhanced sonography detect bowel wall fibrosis in mixed inflammatory and fibrotic Crohn disease lesions in an animal model? J Ultrasound Med 36:523–530CrossRefGoogle Scholar
  22. 22.
    Wilkens R, Hagemann-Madsen RH, Peters DA et al (2018) Validity of contrast-enhanced ultrasonography and dynamic contrast-enhanced MR enterography in the assessment of transmural activity and fibrosis in Crohn's disease. J Crohns Colitis 12:48–56CrossRefGoogle Scholar
  23. 23.
    Chatu S, Pilcher J, Saxena SK et al (2012) Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn's disease: comparative study from the UK. Clin Radiol 67:553–559CrossRefGoogle Scholar
  24. 24.
    Pallotta N, Civitelli F, Di Nardo G et al (2013) Small intestine contrast ultrasonography in pediatric Crohn's disease. J Pediatr 163:778–784CrossRefGoogle Scholar
  25. 25.
    Calabrese E, Maaser C, Zorzi F et al (2016) Bowel ultrasonography in the management of Crohn's disease. A review with recommendations of an international panel of experts. Inflamm Bowel Dis 22:1168–1183CrossRefGoogle Scholar
  26. 26.
    Nagita A, Anemoto K, Yoden A, Yamazaki T (1994) Ultrasonographic diagnosis of juvenile colonic polyps. J Pediatr 124:535–540CrossRefGoogle Scholar
  27. 27.
    Gaca AM, Jaffe TA, Delaney S et al (2008) Radiation doses from small-bowel follow-through and abdomen/pelvis MDCT in pediatric Crohn disease. Pediatr Radiol 38:285–291CrossRefGoogle Scholar
  28. 28.
    Duigenan S, Gee MS (2012) Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol 199:907–915CrossRefGoogle Scholar
  29. 29.
    Quencer KB, Nimkin K, Mino-Kenudson M, Gee M (2013) Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38:705–713CrossRefGoogle Scholar
  30. 30.
    Brogan PA, Malik M, Shah N et al (2006) Systemic vasculitis: a cause of indeterminate intestinal inflammation. J Pediatr Gastroenterol Nutr 42:405–415CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Tom A. Watson
    • 1
    Email author
  • Philippe Petit
    • 2
  • Thomas A. Augdal
    • 3
  • E. Fred Avni
    • 4
  • Costanza Bruno
    • 5
  • M. Beatrice Damasio
    • 6
  • Kassa Darge
    • 7
  • Damjana Kjucevsek
    • 8
  • Stéphanie Franchi-Abella
    • 9
  • Donald Ibe
    • 10
  • Annemieke Littooij
    • 11
  • Luisa Lobo
    • 12
  • Hans J. Mentzel
    • 13
  • Marcelo Napolitano
    • 14
  • Aikaterini Ntoulia
    • 15
  • Michael Riccabona
    • 16
  • Samuel Stafrace
    • 17
  • Magdalena Wozniak
    • 18
  • Lil-Sofie Ording Müller
    • 19
  1. 1.Department of Radiology,Great Ormond Street Hospital for Children NHS Foundation Trust,LondonUK
  2. 2.Service d’Imagerie Pédiatrique et PrénataleHôpital Timone EnfantsMarseilleFrance
  3. 3.Department of RadiologyUniversity Hospital of North NorwayTromsøNorway
  4. 4.Department of Pediatric Radiology, Jeanne de Flandre HospitalCHRU de LilleLilleFrance
  5. 5.Department of RadiologyRadiology Institute,VeronaItaly
  6. 6.Department of RadiologyG. Gaslini Institute,GenoaItaly
  7. 7.Department of Radiology, The Children’s Hospital of PhiladelphiaUniversity of Pennsylvania,PhiladelphiaUSA
  8. 8.Department of Diagnostic Imaging, University Children’s HospitalLjubljanaSlovenia
  9. 9.Department of Paediatric Radiology, Hôpital Bicêtre - Hôpitaux Universitaires Paris-SudUniversité Paris-Sud,OrsayFrance
  10. 10.Department of Radiology,Ahmadu Bello University Teaching Hospital Shika,ZariaNigeria
  11. 11.Princess Maxima Center for Pediatric OncologyWilhelmina Children’s Hospital Utrecht/UMCU,Utrechtthe Netherlands
  12. 12.Department of Radiology, Hospital de Santa Maria-CHLNUniversity Hospital,LisbonPortugal
  13. 13.Section of Pediatric Radiology, Institute of Diagnostic and Interventional RadiologyUniversity Hospital Jena,JenaGermany
  14. 14.Department of Paediatric Radiology and Neuroradiology,V. Buzzi Children’s Hospital,MilanItaly
  15. 15.Department of RadiologyPoole Hospital NHS Foundation TrustPooleUK
  16. 16.Department of Radiology, Division of Pediatric RadiologyUniversity Hospital Graz,GrazAustria
  17. 17.Sidra MedicineDohaQatar
  18. 18.Department of Pediatric RadiologyMedical University of LublinLublinPoland
  19. 19.Department of Radiology and Nuclear Medicine, Unit for Paediatric RadiologyOslo University HospitalOsloNorway

Personalised recommendations