SICUS is a very promising technique in children with CD, but its use www.selleckchem.com/products/Paclitaxel(Taxol).html in pediatric patients has still to be investigated. CROSS SECTIONAL IMAGING Good distension of SB loops during the CT and MRI examination is crucial for the correct evaluation of bowel wall abnormalities since collapsed SB loops are difficult to evaluate for bowel wall thickening or hyper-enhancement. Distension of the SB can be achieved by fluid administration after naso-jejunal intubation (CT/MR enteroclysis)[45,46] or per Os (CT/MR enterography)[47,48]. Although better distension of the loops is obtained with the MR/CT enteroclysis, there are various studies that show comparable accuracy between the two techniques[20,45,47,48].

The placement of the nasojejunal tube, necessary for the enteroclysis, is invasive, requires the use of ionizing radiations, which also entails the need for coordination between MR/CT suites and fluoroscopy units, and it can be very anxiety provoking resulting in poor patient tolerance. Moreover, the increased time and costs compared to enterography, make CT/MR enterography the preferred imaging method, respect to CT/MR enteroclysis, in pediatric patients. An important limitation of CT/MR enterography is the need to drink an important amount of fluid in a short time, particularly uncomfortable in young patients. The assessment of mucosal abnormalities requires a correct distension of the loops obtained only with a proper timing of the study both in scanning or fluid ingestion. The collapsed bowel loops may mimic wall thickening and hyper-enhancement, leading to false-positive results.

The younger patients and the parents have to be motivated and aware of the importance of performing an adequate SB distension, which is fundamental for obtaining an optimal MR examination. The presence of a parent in the MR room is reassuring for younger children. Most children diagnosed with IBD are of school age or adolescence. In a study from uniform data collected from a cohort of pediatric patients with IBD (1370 children), the mean age at diagnosis was 10.3 years with 47.7% diagnosed at 6 to 12 years of age and 36.9% at 13 to 17 years of age[49]. In our experience, children of this age are generally able to undergo the exam without sedation. In the event a child refuses to drink the contrast agent, we will offer placement of a temporary nasogastric tube for contrast agent delivery. The enteric tube will be removed right after all of the contrast material is given Brefeldin_A and before the MR examination begins. Patients under the age of 6 years, who require anesthesia do not undergo MR enterography and are usually imaged by using high-resolution bowel US or MR enteroclysis under anesthesia. The positioning of the tube takes place after the anesthesia.