array:24 [ "pii" => "S2173510719300345" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2019.03.006" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1109" "copyright" => "SERAM" "copyrightAnyo" => "2019" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2019;61:333-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3 "formatos" => array:2 [ "HTML" => 1 "PDF" => 2 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0033833819300013" "issn" => "00338338" "doi" => "10.1016/j.rx.2018.12.003" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1109" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2019;61:333-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 726 "formatos" => array:2 [ "HTML" => 477 "PDF" => 249 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Radiología basada en la evidencia</span>" "titulo" => "Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer?" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "336" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Acute abdominal pain in patients with Crohn's disease: what urgent imaging tests should be done?" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 1583 "Tamanyo" => 220415 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Brote enfermedad de Crohn.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Marazuela García, A. López-Frías López-Jurado, A. Vicente Bártulos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Marazuela García" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Frías López-Jurado" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Vicente Bártulos" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173510719300345" "doi" => "10.1016/j.rxeng.2019.03.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300345?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833819300013?idApp=UINPBA00004N" "url" => "/00338338/0000006100000004/v4_201910151222/S0033833819300013/v4_201910151222/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173510719300412" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2019.04.002" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1120" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Radiologia. 2019;61:337-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Miliary tuberculosis induced by intravesical instillation of bacillus Calmette-Guérin" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "337" "paginaFinal" => "340" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tuberculosis miliar inducida por instilación endovesical de bacilo de Calmette-Guérin" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 459 "Ancho" => 1255 "Tamanyo" => 82295 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Axial slices of the intravenous contrast-enhanced CT scan of the chest and abdomen, with lung window. Bilateral miliary-type interstitial pattern, as well as right-sided basal peripheral infiltrates.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Osorio Aira, L. Casadiego Matarranz, N. Andrés García, M.R. López Pedreira" "autores" => array:4 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Osorio Aira" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Casadiego Matarranz" ] 2 => array:2 [ "nombre" => "N." "apellidos" => "Andrés García" ] 3 => array:2 [ "nombre" => "M.R." "apellidos" => "López Pedreira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833819300128" "doi" => "10.1016/j.rx.2019.01.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833819300128?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300412?idApp=UINPBA00004N" "url" => "/21735107/0000006100000004/v2_201907190802/S2173510719300412/v2_201907190802/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510719300540" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2019.05.003" "estado" => "S300" "fechaPublicacion" => "2019-07-01" "aid" => "1123" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2019;61:324-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Metastases to the breast, an uncommon diagnosis: What do radiologists need to know?" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "324" "paginaFinal" => "332" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Metástasis en la mama, un diagnóstico infrecuente. ¿Qué deben saber los radiólogos?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1781 "Ancho" => 3167 "Tamanyo" => 608919 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Case 5. 74-year-old woman diagnosed one year prior with neuroendocrine tumour of the intestine. (A) Left breast mammography with mediolateral oblique and craniocaudal incidence and incidence magnified in the upper outer quadrant (UOQ) where a dense, oval nodule with microlobulated margins is observed (red arrow). (B) Left breast ultrasound of the UOQ where a hypoechoic, oval nodule is observed, solid, with microlobulated margins, with positive Doppler (red arrow). (C) Anatomical pathology (haematoxylin–eosin 2.5× and 10×): neuroendocrine tumour with a glandular pattern in “nests” and with nuclear hyperchromatism; manifests typical round or oval nuclei with irregular stippled nucleoli. Immunohistochemistry: positive chromogranin.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "K. Pesce, M.J. Chico, J. Sanabria Delgado, A.C. Zabala Sierra, C. Hadad, A. Wernicke" "autores" => array:6 [ 0 => array:2 [ "nombre" => "K." "apellidos" => "Pesce" ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Chico" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Sanabria Delgado" ] 3 => array:2 [ "nombre" => "A.C." "apellidos" => "Zabala Sierra" ] 4 => array:2 [ "nombre" => "C." "apellidos" => "Hadad" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Wernicke" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833819300347" "doi" => "10.1016/j.rx.2019.02.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833819300347?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300540?idApp=UINPBA00004N" "url" => "/21735107/0000006100000004/v2_201907190802/S2173510719300540/v2_201907190802/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Evidence-based radiology</span>" "titulo" => "Acute abdominal pain in patients with Crohn's disease: What urgent imaging tests should be done?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "333" "paginaFinal" => "336" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Marazuela García, A. López-Frías López-Jurado, A. Vicente Bártulos" "autores" => array:3 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Marazuela García" "email" => array:1 [ 0 => "marakb33@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Frías López-Jurado" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Vicente Bártulos" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 1583 "Tamanyo" => 182886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Crohn's disease flare-up.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical problem</span><p id="par0005" class="elsevierStylePara elsevierViewall">Crohn's disease (CD) is an inflammatory bowel disease of autoimmune aetiology which, although predominantly affecting the gastrointestinal system, also has systemic involvement. The most common signs and symptoms are abdominal pain and an increase in the daily number of liquid stools. Patients may also suffer from weight loss, analytical alterations (anaemia, iron deficiency, abnormal liver function tests), rectal bleeding and more serious complications, such as fistulas, strictures and intestinal obstructions, perforations and abscesses. There can also be a variety of extraintestinal manifestations, including rheumatological, dermatological and ophthalmic.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The incidence is 3.1–20.2 cases per 100,000 person-years. The fact that CD tends to be diagnosed at an early age and follows a chronic course with complications (30–50%) means these patients have frequent visits to emergency departments.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2,3</span></a> The management of abdominal complications, mainly abscesses, fistulas and strictures with intestinal obstructions, is similar to acute abdomen in patients without CD, with everything that it implies in terms of diagnosis, plain X-rays, ultrasound (US) and computed tomography (CT).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In CD, this clinical scenario means that patients can receive very high cumulative doses of radiation. It is therefore necessary to consider which tests involve the lowest levels of ionising radiation but provide the best diagnostic accuracy to ensure proper management of CD in the emergency department.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical question</span><p id="par0020" class="elsevierStylePara elsevierViewall">We formulated the clinical question following the Patient-Intervention-Outcome (PIO) strategy: What imaging tests should be performed in a patient with a flare-up of Crohn's disease who comes to the emergency department with abdominal pain (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>)?</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Search strategy used</span><p id="par0025" class="elsevierStylePara elsevierViewall">From March to August 2017, we carried out an efficient search following the Haynes pyramid<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> on the radiological management of acute flare-ups in CD with the terms specified in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Using MeSH terms and free terms, we consulted the meta-search engine ACCESSSS<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> and obtained literature references in abstract form (UpToDate and DynaMed).<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1–3</span></a> We also searched databases, such as PubMed and Trip Database, finding clinical practice guidelines (European Crohn's and Colitis Organisation-European Society of Gastrointestinal and Abdominal Radiology [ECCO-ESGAR])<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6–8</span></a> and guidelines on appropriateness (American College of Radiology [ACR]),<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> and carried out a systematic review.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> A total of 133 documents were obtained, but we found no management algorithms with sufficient scientific evidence. In November 2018 the search was updated using the same terms, but we still found no relevant references.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We analysed the publications which were of use for the PIO question and presented the highest level of evidence: the systematic review,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> the ECCO-ESGAR clinical practice guidelines<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">6–8</span></a> and the ACR Appropriateness Criteria.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Critical reading</span><p id="par0040" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0045" class="elsevierStylePara elsevierViewall">In 2011, Panés et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> published a systematic review covering from 1994 to 2010 and including a final selection of 68 articles; levels of evidence (LE) and grade of recommendation (GR) were generated according to the criteria agreed by the Oxford Centre for Evidence-Based Medicine. In the section on diagnosis of complications, they analysed the US, CT and magnetic resonance imaging (MRI) studies carried out to detect fistulas, abscesses and strictures. For the diagnosis of <span class="elsevierStyleItalic">fistulas</span> they concluded that the three techniques had high sensitivity (Se) (US 74%, CT 70%, MRI 76%) and specificity (Sp) (US 95%, CT 97%, MRI 96%), with similar diagnostic accuracy (LE-2, GR-B). Se and Sp were also high for the techniques used to detect <span class="elsevierStyleItalic">abscesses</span> (US: Se 84%, Sp 93%; CT: Se 84%, Sp 97%; and MRI: Se 86%, Sp 93%), with CT and MRI showing greater diagnostic accuracy (LE-2, GR-B). Last of all, to identify areas of <span class="elsevierStyleItalic">stricture</span>, they reported that all three techniques showed high Se (US 79%, CT 89%, MRI 89%) and Sp (US 92%, CT 99%, MRI 94%) with similar diagnostic accuracy. These data are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0050" class="elsevierStylePara elsevierViewall">The evidence-based consensus guidelines developed by ECCO and ESGAR published in 2013<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> establish a series of conclusions on each of the techniques and their use in the diagnosis of the most common intra-abdominal complications:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0055" class="elsevierStylePara elsevierViewall">US, CT and MRI have high Se and Sp (>80%) for the diagnosis of strictures affecting the small intestine. The diagnostic accuracy of MRI and CT is based on the use of intraluminal contrast (LE-2).</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0060" class="elsevierStylePara elsevierViewall">The accuracy of each of the techniques depends on the type of inflammatory process and the severity (LE-1).</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0065" class="elsevierStylePara elsevierViewall">Ultrasound, CT and MRI have high accuracy in the diagnosis of penetrating complications (fistula, abscess, etc.) (LE-1).</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0070" class="elsevierStylePara elsevierViewall">For deep-penetrating fistulas, CT and MRI are preferable to ultrasound (LE-4).</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0075" class="elsevierStylePara elsevierViewall">Abdominal US and plain abdominal X-ray should be considered in all patients with acute abdominal pain and established CD. CT should be considered in patients with suspected perforation and negative or inconclusive first-line tests (LE-2).</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">3.</span><p id="par0080" class="elsevierStylePara elsevierViewall">The ACR guide for CD<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> presents a single clinical scenario in acute flare-up (leucocytosis, pyrexia, abdominal pain, etc.), for which they recommend as the most appropriate test (9/9) CT with enterography, followed by CT with intravenous contrast or MRI (8/9) and US (5/9).</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Applicability and conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">According to the highest quality evidence currently available, the main conclusion after this review is that there are no significant differences between the techniques described (US, CT and MRI) for the diagnosis of the most common acute complications in CD.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The ACR<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> guidelines establish different grades of recommendation, but only present one single clinical scenario in which to apply them, without specifying clinical suspicions (abscesses, fistulas or strictures) or degrees of severity.</p><p id="par0095" class="elsevierStylePara elsevierViewall">No validated algorithm was found for choosing the ideal imaging test. However, following our analysis of the literature, we, the investigators (radiologists, gastroenterologists, emergency and internal medicine specialists and methodologists), and the centres included in the MAPAC-Imagen II project (<span class="elsevierStyleItalic">Mejora de la Adecuación de la Práctica Asistencial y Clínica en pruebas de Imagen</span> [Improvement in the appropriateness of care provision and clinical practice in imaging tests]), have reached a panel of expert (Delphi type) consensus on a system of management based on clinical and analytical parameters, the Harvey-Bradshaw scale<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> (numerical index of disease activity based on five variables, which are obtained quickly and easily by means of a brief medical history) and SIRS (systemic inflammatory response syndrome) parameters (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">The resulting algorithm, the level of evidence of which would be classed as “expert opinion”, is based mainly on the similar efficacy of the different diagnostic techniques (US, CT and MRI). Additionally, the stratification of severity according to clinical parameters only permits candidates for urgent surgical/interventional treatment to undergo a test with ionising radiation (CT). Other advantages are that practically all patients are assessed by imaging tests with high Se and Sp (US) and the initial plain abdominal X-ray is avoided in many patients.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Source of funding</span><p id="par0105" class="elsevierStylePara elsevierViewall">MAPAC-IMAGEN II (<span class="elsevierStyleItalic">Mejora de la Adecuación de la Práctica Asistencial y Clínica en pruebas de Imagen</span> [Improvement in the appropriateness of care provision and clinical practice in imaging tests]) Working Group. This study received funding from the <span class="elsevierStyleGrantSponsor" id="gs1"><span class="elsevierStyleItalic">Instituto de Salud Carlos III</span> [Carlos III Health Institute]</span> (State Plan for R&D&i 2013–2016) Projects (P16/00296, PI16/01786, P16/01828, P16/00558) and it was co-financed by the <span class="elsevierStyleGrantSponsor" id="gs2">European Regional Development Fund (ERDF)</span>, “A way to make Europe”.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Authorship</span><p id="par0110" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">1.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Responsible for the integrity of the study: PMG.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">2.</span><p id="par0120" class="elsevierStylePara elsevierViewall">Study conception: PMG and AVB.</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">3.</span><p id="par0125" class="elsevierStylePara elsevierViewall">Study design: PMG and ALFLJ.</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">4.</span><p id="par0130" class="elsevierStylePara elsevierViewall">Data acquisition: PMG.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">5.</span><p id="par0135" class="elsevierStylePara elsevierViewall">Analysis and interpretation of the data: PMG and AVB.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">6.</span><p id="par0140" class="elsevierStylePara elsevierViewall">Statistical processing: N/A.</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">7.</span><p id="par0145" class="elsevierStylePara elsevierViewall">Literature search: PMG and ALFLJ.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">8.</span><p id="par0150" class="elsevierStylePara elsevierViewall">Drafting of the paper: PMG.</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">9.</span><p id="par0155" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with relevant intellectual contributions: PMG, AVB and ALFLJ.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">10.</span><p id="par0160" class="elsevierStylePara elsevierViewall">Approval of the final version: PMG and AVB.</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1220920" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1135474" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1220921" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1135473" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical problem" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical question" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Search strategy used" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Critical reading" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Applicability and conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Source of funding" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Authorship" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflicts of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-09-25" "fechaAceptado" => "2018-12-20" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1135474" "palabras" => array:6 [ 0 => "Crohn disease" 1 => "Inflammatory bowel diseases" 2 => "Tomography, X-ray computed" 3 => "Magnetic resonance imaging" 4 => "Ultrasonography" 5 => "Emergency Medicine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1135473" "palabras" => array:6 [ 0 => "Enfermedad de Crohn" 1 => "Enfermedad inflamatoria intestinal" 2 => "Tomografía computarizada" 3 => "Resonancia magnética" 4 => "Ecografía" 5 => "Emergencias" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Crohn's disease is an autoimmune disease that predominantly affects the gastrointestinal tract. Crohn's disease is diagnosed at a young age and runs a chronic course with acute flare-ups. When patients with Crohn's disease present with flare-ups at the emergency department, they are usually managed in a way similar to patients with acute abdomen; there is no consensus about the most appropriate imaging work-up for patients with flare-ups of Crohn's disease. Thus, we decided to review the literature about the imaging tests indicated (whether related to their diagnostic performance or to lower exposure to ionizing radiation) for acute flare-ups in patients with Crohn's disease.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La enfermedad de Crohn es una patología de etiología autoinmunitaria, con afectación predominante del aparato digestivo. Se trata de una enfermedad que se diagnostica a edad temprana y presenta un curso crónico con reagudizaciones. Estos brotes se suelen manejar de forma similar a un abdomen agudo en los pacientes que acuden a los servicios de urgencias, y no existe un consenso sobre cuáles serían las pruebas de imagen más adecuadas. Debido a esta controversia, se ha decidido realizar una revisión de la bibliografía actual sobre cuáles serían las pruebas de imagen indicadas (ya sea por rendimiento diagnóstico o por menor exposición a radiación ionizante) en el brote agudo de pacientes con enfermedad de Crohn.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Marazuela García P, López-Frías López-Jurado A, Vicente Bártulos A. Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer? Radiología. 2019;61:333–336.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1054 "Ancho" => 1583 "Tamanyo" => 182886 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Crohn's disease flare-up.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">PIO: Patient-Intervention-Outcome.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Intervention \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outcome \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Crohn's disease ORInflammatory bowel diseases OREmergencies, Emergency Medicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">X-rays ORUltrasonography ORTomography, X-ray computed ORMagnetic resonance imaging \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AND \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diagnosis \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084966.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Clinical question according to the PIO strategy.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; CT: computed tomography; MRI: magnetic resonance imaging; Se: sensitivity; Sp: specificity.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Panés et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Abscesses \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Strictures \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fistulas \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ultrasound \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>84%(95% CI: 79–88%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>93%(95% CI: 89–95%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>79%(95% CI: 71–84%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>92%(95% CI: 87–96%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>74%(95% CI: 67–79%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>95%(95% CI: 91–97%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CT \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>84%(95% CI: 78–90%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97%(95% CI: 94–99%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>89%(95% CI: 83–94%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>99%(95% CI: 97–100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>70%(95% CI: 64–76%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>97%(95% CI: 94–99%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MRI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>86%(95% CI: 79–91%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>93%(95% CI: 88–97%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>89%(95% CI: 84–92%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>94%(95% CI: 90–96%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Se<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>76%(95% CI: 71–82%)Sp<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>96%(95% CI: 92–98%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2084967.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Diagnostic accuracy of imaging tests in complications of Crohn's disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Peppercorn M, Kane S. Clinical manifestations, diagnosis and prognosis of Crohn Disease in adults. In: Post TW, editor. UpToDate. Waltham, MA: UpToDate Inc. Available from: <a href="https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-prognosis-of-crohn-disease-in-adults">https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-prognosis-of-crohn-disease-in-adults</a> [updated 19.11.18; accessed 20.11.18]." ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Peppercorn M, Cheifetz A. Definition, epidemiology, and risk factors in inflammatory bowel disease. In: Post TW, editor. UpToDate. Waltham, MA: UpToDate Inc. Available from: <a href="https://www.uptodate.com/contents/definition-epidemiology-and-risk-factors-in-inflammatory-bowel-disease">https://www.uptodate.com/contents/definition-epidemiology-and-risk-factors-in-inflammatory-bowel-disease</a> [updated 17.01.18; accessed 20.11.18]." ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Weiner B, van Zuuren E, Ehrlich A. Crohn disease in adults. Dynamed.com. Available from: <a href="http://www.dynamed.com/topics/dmp~AN~T114217/Crohn-disease-in-adults">http://www.dynamed.com/topics/dmp∼AN∼T114217/Crohn-disease-in-adults</a> [updated 16.05.18; accessed 19.11.18]." ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Accessing preappraised evidence: fine-tuning the 5S model into a 6S model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. DiCenso" 1 => "L. Bayley" 2 => "R.B. Haynes" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "ACP J Club" "fecha" => "2009" "volumen" => "151" "paginaInicial" => "2" "paginaFinal" => "3" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Accessss.org. ACCESSSS | Home. Available from: <a href="https://www.accessss.org/">https://www.accessss.org/</a> [accessed 08.11.18]." ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Panes" 1 => "Y. Bouhnik" 2 => "W. Reinisch" 3 => "J. Stoker" 4 => "S.A. Taylor" 5 => "D.C. Baumgart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.crohns.2013.02.020" "Revista" => array:6 [ "tituloSerie" => "J Crohns Colitis" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "556" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23583097" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "3rd European Evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 1: Diagnosis and medical management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Gomollón" 1 => "A. Dignass" 2 => "V. Annese" 3 => "H. Tilg" 4 => "G. Van Assche" 5 => "J.O. Lindsay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ecco-jcc/jjw168" "Revista" => array:6 [ "tituloSerie" => "J Crohns Colitis" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "3" "paginaFinal" => "25" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27660341" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0095" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "3rd European evidence-based consensus on the diagnosis and management of Crohn's disease 2016: Part 2: Surgical management and special situations" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Gionchetti" 1 => "A. Dignass" 2 => "S. Danese" 3 => "M. Dias" 4 => "F. José" 5 => "G. Rogler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/ecco-jcc/jjw169" "Revista" => array:6 [ "tituloSerie" => "J Crohns Colitis" "fecha" => "2017" "volumen" => "11" "paginaInicial" => "135" "paginaFinal" => "149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27660342" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0100" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ACR appropriateness criteria Crohn disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.H. Kim" 1 => "L.R. Carucci" 2 => "M.E. Baker" 3 => "B.D. Cash" 4 => "J.R. Dillman" 5 => "B.W. Feig" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacr.2015.07.005" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Radiol" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "1048" "paginaFinal" => "1057" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26435118" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0105" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease: systematic review: cross-sectional imaging in Crohn's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Panés" 1 => "R. Bouzas" 2 => "M. Chaparro" 3 => "V. García-Sánchez" 4 => "J.P. Gisbert" 5 => "B. Martínez de Guereñu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2036.2011.04710.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2011" "volumen" => "34" "paginaInicial" => "125" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21615440" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0110" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A simple index of Crohn's-disease activity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.F. Harvey" 1 => "J.M. Bradshaw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Lancet" "fecha" => "1980" "volumen" => "315" "paginaInicial" => "514" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735107/0000006100000004/v2_201907190802/S2173510719300345/v2_201907190802/en/main.assets" "Apartado" => array:4 [ "identificador" => "77331" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Evidence- based radiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735107/0000006100000004/v2_201907190802/S2173510719300345/v2_201907190802/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510719300345?idApp=UINPBA00004N" ]
Journal Information
Share
Download PDF
More article options
Evidence-based radiology
Acute abdominal pain in patients with Crohn's disease: What urgent imaging tests should be done?
Dolor abdominal agudo en la enfermedad de Crohn. ¿Qué prueba de imagen urgente se debe hacer?
P. Marazuela García
, A. López-Frías López-Jurado, A. Vicente Bártulos
Corresponding author
Servicio de Radiología, Hospital Universitario Ramón y Cajal, Madrid, Spain