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

Abstract

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.

Treat-to-target in Crohn’s disease: Will transmural healing become a therapeutic endpoint?

“…Nowadays, given their non-invasiveness, non-irradiation and high accuracy, MRE and US are considered the most appropriate techniques to monitor CD patients after treatment[ 18 ]. Benefits and limits of CTE, MRE and US have been extensively presented in recent reviews[ 53 , 55 - 61 ], systematic reviews and meta-analyses[ 52 , 62 ], and consensus guidelines[ 53 , 63 - 65 ]; therefore, they are beyond the scope of this review. Validated CSI scores to quantify activity in CD are mainly based on MRE[ 55 , 56 , 58 ].…”

Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

“…These endoscopic methods enable to accurately detect the luminal inflammation with high sensitivity[11], whereas their common weakness can be related to the transmural nature of inflammation caused by CD[12]. MRE is a noninvasive cross-sectional examination technique that may overcome this weakness of endoscopy, but it is less sensitive than endoscopy in detecting stenosis and superficial inflammation[6, 13–15].…”

Introductory Chapter: Inflammatory Bowel Disease

“…The patient usually drinks an oral contrast, and intravenous contrast may also be injected into a vein prior to the test. Magnetic resonance (MR) enterography has the advantage over other methods of being detection active inflammation noninvasive, lacking ionizing radiation, and demonstrating excellent soft tissue contrast to evaluate patients with inflammatory bowel disease [41].…”