Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Abstract

Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

117 Diagnostic Yield of Capsule Endoscopy Versus Magnetic Resonance Enterography and Small Bowel Contrast Ultrasound for Evaluation of Small Bowel Crohn's Disease; a Systematic Review and Meta-Analysis

“…An additional limitation of our analysis is that we limited it to studies using CE as a comparator. Alternative diagnostic techniques for the modalities discussed in the study are available and some are well established for diagnosis and monitoring of CD (such as diffusion weighted MRE, bubble-enhanced or non-contrast enhanced intestinal US), however we could not discuss those as there was no sufficient data for comparison with CE [48][49][50]. As for CT enterography, a previous analysis by Dionisio et al performed a thorough analysis of its accuracy as compared to VCE [3].…”

Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement

“…However, problems associated with MR include noncompliance with breath-holding, motion artefacts, and requirement of general anesthesia in younger children. [50] In a study of 85 children with IBD (age range: 9–18 years) who underwent MRE without sedation, MR was acceptable to most of the children (93%) with adequate distension of intestine and good image quality. The authors of this study concluded that MR is acceptable and can be done without sedation in children more than 9 years of age.…”

MR Enterography in Pediatric Inflammatory Bowel Disease- Where do we Stand?

“…MR enterography gives excellent details of the lumen, bowel wall and perienteric abnormalties. (7) Imaging findings commonly found include those of active inflammation like bowel wall thickening with hyperenhancement, edema, restricted diffusion in DWI, mesenteric hypervascularity(comb's sign), fat stranding, fibrofatty proliferation or complications like stricture, fistula, abscesses, perianal disease (Figures 1a,1b,2a,2b). Imaging findings associated with active inflammation, stricturing and penetrating crohns disease are presented in table 1.…”