Purpose or Case Report: The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are multifaceted disorders as a consequence of complex interplay between genetic, environmental and immunological factors, leading to a dysregulated immune response of the host intestinal bacteria. In children both the mucosal immune system and the intestinal microflora are still developing. Taken together, it seems that patients with early onset IBD (EO-IBD) are a unique subset within IBD with particular gene defects, phenotypic appearance, drug responsiveness and immune pathology.
Imaging plays a key role in the diagnosis and follow-up of EO-IBD, with MRI enterography being the gold standard in modern IBD practice, largely because of its ability to provide excellent spatial resolution without ionising radiation. EO-IBD can also be elegantly demonstrated on ultrasound and can be used a complimentary imaging tool in both the diagnostic workup and follow up imaging.
The aims of this educational exhibit are to:
(i) Provide a pictorial review of the key imaging finding of EO-IBD as demonstrated on MRI and ultrasound.
(ii) Review the imaging techniques and protocols for MR enterography as applied to EO-IBD.
(iii) Discuss the role of genetic mutations and innate immune defects in the pathophysiology of EO-IBD.
Methods & Materials: Images provided are from retrospective review over a 10 year period (2005 - 2015) of confirmed cases of EO-IBD who were managed at our institution.
Results: N/A.
Conclusions: EO-IBD is a distinct subtype of IBD and differs from later onset and adult IBD with regards to genetics, disease location and responsiveness to treatment. Paediatric radiologists must have a solid knowledge and understanding of the optimum imaging techniques and protocols to facilitate diagnosis, and also be familiar with the key imaging findings and disease distribution in EO-IBD.