Introduction

A condition that is long-term and can occur at any age in any individual? A condition that solely focuses on impacting the digestive system? Crohn’s disease is exactly that.¹ It can result in symptoms like abdominal pain, fatigue, diarrhoea and even poor overall growth in children.² It is often misdiagnosed as other gastrointestinal disorders, making it challenging for the appropriate treatment to be given. Therefore, early detection and targeted assessments are critical for effective treatment, which can be achieved through medical imaging that identifies inflammation.

Imaging techniques allow healthcare professionals to observe detailed pictures of the intestines and tissues without the need for invasive surgery. Determining the exact location of diseases, such as abscesses or fistulas, and their severity allows the extent of the disease to be determined.³ Understanding the importance of different types of imagining methods, alongside their limitations, can aid individuals, especially children, in receiving adequate care.

Importance of imaging in paediatric crohn’s disease

In children, the diagnosis of Crohn’s disease poses a variety of difficulties. For example, abdominal pain, diarrhoea, and even weight loss are non-specific symptoms that can be found in other digestive conditions. Whilst blood and stool tests can indicate inflammation, their results cannot pinpoint the exact location or severity of any disease.⁴ Hence, imaging techniques are used to observe the inside of the digestive tract safely; these are non-invasive and give specific results at the comfort of patients. The techniques reveal the location of inflammation or any structural changes, such as strictures, that may have occurred, causing further symptoms. 

Another advantage of imaging is that it helps monitor treatment.⁵ Through observing how well a child is responding to different types of care, such as whether the disease is improving or progressing, detailed information results in an effective response. By receiving early insight, there is a significant reduction in the risk of potential complications, such as the worsening of symptoms.

Common imaging techniques used

Ultrasound

One of the techniques used to identify Crohn’s disease is Ultrasound. It is a relatively safe and quick procedure, causes no harm to the children. This is because it is free from any radiation; the technique uses sound waves instead to form real-time images.⁶ Thus, showcasing the thickening of bowel walls and if there is any increase in blood flow or fluid retention, the first signs of inflammation. 

Ultrasound is vital for detecting complications such as abscesses or enlarged lymph nodes, and the techniques can be used regularly to monitor changes with no harm. Despite the harmless advantages, the accuracy of the real-time pictures formed is dependent on the operator using the machine. This can lead to a potential subjective interpretation of the visuals provided.

Nonetheless, ultrasound is considered to be a critical first-line tool used to determine Crohn’s disease, especially in children, as it ensures safety and comfort.⁷

Magnetic resonance enterography

Another technique is Magnetic Resonance Enteorgraphy (MRE). This is a relatively advanced tool that uses magnetic fields and radio waves, unlike ultrasound, which uses sound waves.⁸ As a result, it can produce vastly more accurate and detailed images that show inflammation strictures and fistulas, often associated with Crohn’s disease.⁹ This is another scan in which there is no radiation exposure involved, making it safe and ideal for children who require repeated scans to monitor their disease.

However, one challenging step in undergoing an MRE is the requirement to drink a contrast solution, which may be inconvenient for young children. This solution allows for the bowel to be seen much more easily and in more detail. Hence, this is another imaging tool that is safe and painless in guiding individuals, especially children, in the diagnostic process. 

Computed tomography scan

On the other hand, Computed Tomography (CT) uses X-rays to produce cross-sectional images of the intestines, making it well-suited for targeting a specific site in high detail.¹⁰ Also, it plays a vital role in urgent situations. For example, when an abscess, perforation or even severe inflammation is suspected, rapid diagnosis is crucial for effective care.¹¹ This is when CT scans become essential for healthcare professionals.

Although CT scans can provide precise and quick results, children are at high risk of exposure to ionising radiation, which is very harmful when frequently used. Therefore, CT scans are almost always only used in emergencies or when other diagnostic methods are not suitable.¹² The value a CT scan holds should still be taken into consideration due to its rapid results and precise imaging.

Small bowel follow-through

A traditional X-ray method that is still used to specifically examine the small intestine is the Small Bowel Follow-Through (SBFT). Through this procedure, abnormalities such as narrowed or inflamed areas can be observed.¹³ This is achieved through the individual drinking a contrast solution that contains barium, coating the lining of the small intestine, which makes it more visible through X-ray images. Like MRE, the contrast solution can be challenging to take, especially for young children. 

Furthermore, ionising radiation is present, whilst the method offers less detailed images than MRI or ultrasound.¹⁴ Therefore, SBFT is less frequently used than other imaging tools. Nonetheless, this method can still play a role in assessing the small intestine when other imaging techniques are unavailable.

Endoscopy and capsule endoscopy

Whilst endoscopy and capsule endoscopy do not qualify as imaging scans, they remain crucial diagnostic tools for determining Crohn’s disease. Indeed, endoscopy provides a direct, real-time view of the intestinal lining using a thin, flexible camera that can also acquire biopsies.¹⁵ These can further be used for examination through a microscope, which is significant to differentiate Crohn’s disease from other digestive diseases, whilst also assessing its severity. 

Whereas capsule endoscopy involves ingesting a small tablet containing a thin camera that takes pictures throughout its passage through the digestive tract. As a result, it can provide detailed images of areas that can often be hard to reach with standard endoscopy.¹⁶ 

Both procedures can be uncomfortable for children, often requiring general anaesthesia so they can stay calm and still during the process. Also, as it requires foreign objects such as cameras and tablets inside the body, it can be considered invasive, further creating difficulties for children undergoing the procedure.

Choosing the right imaging technique

You may wonder how the most appropriate imaging method is chosen, especially when considering Crohn’s disease. This depends on the symptoms presented and the individual's age. A trained specialist must choose the most appropriate one, as each tool has its own unique advantages.¹⁷

Often, more than one tool is used to gain an overall understanding of any conditions. Not only is imaging vital diagnosis of Crohn’s disease, but it also plays an important role in the monitoring of the disease’s progression and how the treatment is affecting the child over time. 

Image accuracy and safety are balanced by prioritising non-radiation methods like ultrasound and MRI for children who are still growing.¹⁸ To acquire the most accurate diagnosis specific to Crohn’s disease, medical imaging must be paired with blood and stool tests.¹⁹

Through clinical examination, healthcare professionals are given a complete picture of the disease and its effects, allowing for personalised treatment for each patient. 

The role of imaging in ongoing care

Through regular imaging, specific complications such as strictures, fistulas, and abscesses can be detected and treated accordingly. By providing prompt treatment, serious health issues can be addressed, and Crohn’s disease managed.²⁰ Indeed, through long-term management support given through the use of medical imaging, hospital admissions alongside invasive procedures can be reduced. This positively impacts the affected children and maintains a better quality of life.

Summary

In summary, medical imaging plays an essential role in the diagnosis and treatment plan of Crohn’s disease in children. By providing access to the inside of the digestive tract, inflammation and disease-specific complications can be detected early, whilst also allowing for the monitoring of treatments. The safest and preferred tools for children’s imaging are ultrasound and MRI, as they do not pose a risk of radiation. In comparison, CT scans and SPFT are only reserved for emergencies. 

Other methods, such as endoscopy and capsule endoscopy, may not be imaging tools, but they still provide real-time visuals of the digestive tract. Through using these alongside the scans, healthcare professionals can tailor personalised long-term treatment plans for each child, all whilst minimising invasive procedures. Through continued progression in the medical imaging field, children with Crohn’s disease can receive safe and relatively fast diagnosis and treatment.