OBJECTIVES The objectives of this study were prospective evaluation of MR enterographic accuracy for detecting Crohn's disease imaging features in pediatric patients compared with a CT reference standard, as well as determination of MR enterographic accuracy for detecting active bowel inflammation and fibrosis using a histologic reference standard. MATERIALS AND METHODS The study group for this blinded prospective study included 21 pediatric subjects with known Crohn's disease scheduled for clinical CT imaging and histological bowel sampling for symptomatic exacerbation. All subjects and their parents gave informed consent to also undergo MR enterography. CT and MR enterography examinations were independently reviewed by 2 radiologists and scored for Crohn's disease features. All bowel histology specimens were reviewed by a single pathologist for presence of active mucosal inflammation and mural fibrosis, followed by imaging-histological correlation. RESULTS All 21 subjects underwent MR enterography and histological sampling, 18 of whom also underwent CT. MR enterography demonstrated high sensitivity for detecting Crohn's imaging features (bowel wall thickening, mesenteric inflammation, lymphadenopathy, fistula, abscess) compared with CT, with individual sensitivity values ranging from 85.1-100%. Out of a total of 53 abnormal bowel segments with MRI-histology correlation, MR enterography demonstrated 86.7% accuracy (90.0% sensitivity, 82.6% specificity) for detecting active inflammation (P < 0.001). Accuracy of MR enterography for detecting mural fibrosis overall was 64.9% compared with histology, but increased to 88.2% (P < 0.05) for detecting fibrosis without superimposed active inflammation. CONCLUSIONS MR enterography can substitute for CT as the first-line imaging modality in pediatric Crohn's patients, based on its ability to detect intestinal pathology in both small and large bowel as well as extraintestinal disease manifestations. Additionally, MR enterography provides an accurate noninvasive assessment of Crohn's disease activity and mural fibrosis and can aid in formulating treatment strategies for symptomatic patients and assessing therapy response.

Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent. Use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified.

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Symptoms of Crohn’s disease (CD) can be due to active inflammation or fibrosis. Differentiating these based on clinical presentation, endoscopy, laboratory parameters, and clinical scoring methods can be inaccurate and/or invasive. As therapy decisions are often directed based on whether active disease or fibrosis is present, a reliable and non-invasive test to distinguish these two etiologies would be a powerful clinical tool. CT enterography (CT-E) and MR enterography (MR-E) are two non-invasive imaging modalities tailored to evaluate the small bowel. The purpose of our study was to compare the ability of MR-E and CT-E to assess for active inflammation and mural fibrosis in patients with known CD as compared to a histologic reference standard. After obtaining MR-E and CT-E on the same day, a total of 61 histologic samples were obtained from twelve subjects aged 12–20 years via full-thickness bowel resection or endoscopy. These were evaluated by the pathologist for active inflammation and fibrosis. We found that while CT-E and MR-E were similar in their accuracies of depicting active inflammation, MR-E was significantly more sensitive in detecting fibrosis. Because of this and the lack of ionizing radiation from MR-E, we believe that MR-E rather than CT-E should serve as the primary imaging modality for the assessment of CD pediatric patients with non-acute clinical exacerbations.