Radiology, Vol 206, 103-108, Copyright © 1998 by Radiological Society of North America
Duodenitis in children: correlation of radiologic findings with endoscopic and pathologic findings
FR Long, SS Kramer, RI Markowitz and CA Liacouras
Department of Radiology, Columbus Children's Hospital, OH 43205-2696, USA.
PURPOSE: To determine the accuracy of barium studies in the diagnosis of
duodenitis in children. MATERIALS AND METHODS: Seventy-five children (45
boys and 30 girls; mean age, 9 years) underwent upper gastrointestinal (GI)
examinations. Twenty-four of the children had biopsy-proved duodenitis, and
51 were healthy control subjects. Radiologic findings were reviewed by two
experienced, blinded observers and correlated with endoscopic and
histologic results. Duodenal mucosal- fold thickness was measured on spot
radiographs (20% magnification), and the extent of disease was evaluated.
RESULTS: Of 15 children with mild duodenitis, 13 had normal radiologic
findings and 11 had normal findings at esophagogastroduodenoscopy. Of nine
children with severe duodenitis, all had friability or ulceration at
endoscopy and mucosal- fold thickening of greater than or equal to 4 mm
(> or = 3 mm in one infant aged less than 1 year) at upper GI
examination. Mucosal-fold thickening was diffuse in patients with celiac,
autoimmune, and adenovirus disease and was proximal in patients with peptic
ulcer and Crohn disease. Of 51 control subjects, 50 had normal radiologic
results, while 47 had normal endoscopic results. The sensitivity of upper
GI examination for mild and severe duodenitis combined was 46% with a
specificity of 98%, whereas endoscopy had a sensitivity of 54% and
specificity of 92%. CONCLUSION: Mucosal-fold thickening was a specific sign
of duodenitis in children and should be investigated. Upper GI examination
yielded results similar to those at endoscopy.
