Bowel magnetic resonance imaging of pediatric patients with oral mannitol

Abstract

The purpose of this study was to assess the sensitivity, specificity, and diagnostic accuracy of magnetic resonance imaging (MRI) in pediatric patients with clinical suspicion of inflammatory bowel disease (IBD) by comparing MRI and ultrasound (US) to endoscopy, the gold standard. A median volume of 300 ml of mannitol in a 15% [corrected] watery solution were ingested by 43 children prior to examination. The 53 MRI examinations were compared with 20 endoscopies and 41 US of the terminal ileum. The outcomes were MRI quality; pathologic findings; level of adverse events; and concordance between endoscopy, MRI, and US estimated by kappa statistics. The ileum and terminal ileum were very good or excellently imaged in approximately 80% of cases. Wall thickening and enhancement were most frequent in the terminal ileum. MRI compared with endoscopy had a sensitivity of 81.8% [95% confidence interval (CI)], specificity of 100%, diagnostic accuracy of 90%, and kappa value of 0.80 (95% CI), indicating a good degree of concordance. A similar degree of concordance was achieved between US and endoscopy. In spite of the frequent adverse reactions, such as diarrhea and nausea, half of the patients were prepared to repeat the examination. The results of MRI are concordant with endoscopy and US of the terminal ileum.

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

“…Magnetic resonance enterography (MRE) has been used to diagnose active CD in paediatric populations. It reportedly helps to identify disease extent and intestinal complications with adequate diagnostic accuracy, correlating with endoscopic and histological features in the vast majority of children with active CD [4][5][6][7][8][9][10].…”

Feasibility of an optimized MR enterography protocol in the evaluation of pediatric inflammatory bowel disease

“…Moderate distension was 20.6% in the terminal ileum. A previous study that used oral mannitol reached very good or excellent distension in 77.3% and 79.2% of respectively the ileum and terminal ileum (14). Putting our moderate and excellent distension patients, perhaps an area to focus upon in the future.…”

Ultrasonographic findings in Crohn’s disease

“…In recent years, thanks to an increasing experience with the use of ultrasound (US) in the assessment of gastrointestinal diseases, transabdominal US has become a first-line, noninvasive, imaging modality in the diagnosis of inflammatory bowel disease (IBD), with a sensitivity ranging from 84 to 93 % [1,2]. Indeed, transabdominal bowel sonography (TABS) is repeatable, cheap, efficient and virtually hazard free, although quite unspecific; taking this into account its role in primary diagnostics is to detect a pathological feature and guide further investigations.…”