Assessing pediatric ileocolonic Crohn’s disease activity based on global MR enterography scores

Pomerri, Fabio; Bunni, Faise Al; Zuliani, Monica; Guariso, Graziella; Gasparetto, Marco; Giorgi, Benedetta; Cananzi, Mara; Muzzio, Pier Carlo

doi:10.1007/s00330-016-4443-y

Cited by 22 publications

(39 citation statements)

References 27 publications

(42 reference statements)

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“…However, retrospective studies have confirmed that both adults and children with CD may have high levels of cumulative exposure to diagnostic ionizing radiation, drawing attention to the need for alternative, accurate, radiation‐free techniques. In view of this, magnetic resonance enterography (MRE) is now more frequently used to assess pediatric CD, providing an accurate tool to assess disease extent and distribution, depicting both intestinal and extraintestinal disease‐related complications . It is favored due to its inherent multiplanar capability and ability to provide excellent soft‐tissue contrast resolution without exposure to ionizing radiation .…”

Section: Introductionmentioning

confidence: 99%

“…[13][14][15][16][17] In view of this, magnetic resonance enterography (MRE) is now more frequently used to assess pediatric CD, providing an accurate tool to assess disease extent and distribution, depicting both intestinal and extraintestinal disease-related complications. 18 It is favored due to its inherent multiplanar capability and ability to provide excellent soft-tissue contrast resolution without exposure to ionizing radiation. 19 However, it is expensive, time-consuming, and sometimes poorly tolerated, particularly in children who may not be able to lie still during the procedure without a general anesthetic.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

et al. 2019

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Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CD‐related complications were assessed using kappa (κ) coefficient statistics. A total of 93 patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ = 0.73) but fair in TUS (κ = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ = 0.63) and moderate (κ = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ = 0.77) and dilatation (κ = 0.68). Conclusions SICUS offers a radiation‐free alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

et al. 2019

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“…Magnetic resonance enterography (MRE) has become the imaging test of choice for evaluating pediatric CD patients, primarily due to the frequent need for imaging and concerns over the ionizing radiation risk of repeat computed tomography (CT) scans. 6,7 Numerous studies have documented the diagnostic accuracy of MRE [8][9][10][11] and demonstrated statistically significant correlations between magnetic resonance imaging (MRI) with endoscopic findings, histopathology, CT features, and pediatric clinical indices of IBD activity. [10][11][12][13][14] Standard clinical indications for MRE imaging in CD patients include evaluation of disease distribution at the time of initial diagnosis, assessing extent of disease in patients with symptomatic recurrence, tracking progression of extraluminal penetrating disease, and treatment planning in patients with fibrostenotic disease.…”

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confidence: 99%

“…6,7 Numerous studies have documented the diagnostic accuracy of MRE [8][9][10][11] and demonstrated statistically significant correlations between magnetic resonance imaging (MRI) with endoscopic findings, histopathology, CT features, and pediatric clinical indices of IBD activity. [10][11][12][13][14] Standard clinical indications for MRE imaging in CD patients include evaluation of disease distribution at the time of initial diagnosis, assessing extent of disease in patients with symptomatic recurrence, tracking progression of extraluminal penetrating disease, and treatment planning in patients with fibrostenotic disease. 6 More recently, MRE has been shown to be effective for assessing response to treatment, including in two studies demonstrating high accuracy of MRE for detecting endoscopic mucosal healing 15,16 during antitumor necrosis factor alpha (TNFα) therapy.…”

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Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease

Chu

Moran

et al. 2019

Magnetic Resonance Imaging

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Background MR enterography (MRE) is the primary modality for evaluating small bowel disease in pediatric Crohn's patients. Standard clinical practice includes imaging patients at diagnosis and during symptomatic recurrence. The role for MRE in surveillance of asymptomatic Crohn's patients has not yet been established. Purpose To determine whether MRE imaging features are associated with clinical recurrence. Study Type Retrospective. Populations Pediatric Crohn's patients who underwent MRE while asymptomatic, defined by pediatric gastroenterologists using a physician global assessment; 35 MREs were identified. Field Strength/Sequence 1.5T including T2‐weighted single‐shot fast spin echo, balanced steady‐state free precession, diffusion‐weighted, and contrast‐enhanced multiphase T1‐weighted gradient recalled echo sequences. Assessment MREs were reviewed by three radiologists independently for mural thickening, T2‐weighted hyperintensity, diffusion restriction, hyperenhancement, vasa recta engorgement, and overall assessment of disease activity. Two pediatric gastroenterologists reviewed patient medical records for 6 months following MRE to evaluate for recurrence, defined as Crohn's‐related treatment escalation, surgery, or hospitalization. Statistical Tests Fisher's exact test, Wald chi‐square test, and model selection by Akaike information criterion minimization were used to assess statistical significance of MRE imaging features. Results Of 35 MREs identified, seven cases demonstrated clinical recurrence at 6 months (20%); 28 cases remained in remission (80%). Imaging features of active disease were present in 86% of patients with recurrence compared to 29% of patients in remission (P = 0.01). Wall thickening, T2‐weighted hyperintensity, hyperenhancement, and diffusion restriction were significantly associated with recurrence. Multivariate regression analysis determined diffusion restriction to be the best predictor of recurrence within 6 months (P = 0.001, area under the curve 0.786). Data Conclusion MRE performed on young asymptomatic Crohn's patients can identify patients who have a high probability of developing clinical recurrence in a 6‐month period, indicating a potential role for surveillance imaging to assess for subclinical active disease. Level of Evidence: 3 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;50:1955–1963.

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Diagnostic Performance of Magnetic Resonance Enterography for Detection of Active Inflammation in Children and Adolescents With Inflammatory Bowel Disease

Yoon

Suh²,

Kim

et al. 2017

JAMA Pediatr

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IMPORTANCE Magnetic resonance (MR) enterography has the advantage over other techniques of being noninvasive, lacking ionizing radiation, and demonstrating excellent soft-tissue contrast to evaluate pediatric patients with inflammatory bowel disease (IBD).OBJECTIVE To evaluate the diagnostic performance of MR enterography for detection of active inflammation in children and adolescents with known or suspected IBD.DATA SOURCES A search of MEDLINE and EMBASE up to January 2, 2017, was performed to identify studies. Search terms included child, pediatric, adolescent, Crohn disease, inflammatory bowel disease, and magnetic resonance enterography. The search was limited to English-language publications.STUDY SELECTION Studies evaluating the diagnostic performance of MR enterography for detection of active inflammation in pediatric patients with known or suspected IBD were selected. Two reviewers independently assessed the eligibility of the selected articles. DATA EXTRACTION AND SYNTHESISThe study was performed and reported in accordance with the PRISMA guidelines. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modeling. MAIN OUTCOMES AND MEASURESThe diagnostic performance of MR enterography for detection of active inflammation in pediatric patients with known or suspected IBD was the primary outcome. Subgroup analyses and meta-regression were performed. RESULTSEighteen original articles involving a total of 687 patients were included. The summary sensitivity was 83% (95% CI, 75%-89%), the summary specificity was 93% (95% CI, 90%-95%), and the area under the hierarchical summary receiver operating characteristic curve was 0.95 (95% CI, 0.93-0.97). The Higgins I 2 statistics demonstrated substantial heterogeneity in terms of sensitivity (I 2 = 84.1%) and specificity (I 2 = 68.8%). Based on per-patient analysis, the summary sensitivity was 86% (95% CI, 78%-91%) and specificity was 91% (95% CI, 82%-96%). In meta-regression, among the various potential covariates, scanner manufacturer was associated with study heterogeneity.CONCLUSIONS AND RELEVANCE Magnetic resonance enterography, which is a noninvasive, radiation-free modality, demonstrates high diagnostic performance in the diagnosis of active inflammation in pediatric patients with IBD, especially at the per-patient level.

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Assessing pediatric ileocolonic Crohn’s disease activity based on global MR enterography scores

Cited by 22 publications

References 27 publications

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease

Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease

Diagnostic Performance of Magnetic Resonance Enterography for Detection of Active Inflammation in Children and Adolescents With Inflammatory Bowel Disease

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