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

Abstract

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.

Small Bowel Imaging from Stepchild of Roentgenology to MR Enterography: Part I: Guidance in Performing and Observing Normal and Abnormal Imaging Findings

“…Although barium examinations remain a formidable tool in the depiction of mucosal abnormalities, particularly the apthoid lesions of early Crohn disease [2], magnetic Life 2023, 13, 1691 2 of 15 resonance enterography (MRE) possesses the same significant advantages, namely, the delineation of extraintestinal and transmural inflammation, multiplanar evaluation, and high intrinsic soft-tissue resolution, without radiation exposure [3]. In particular, young Crohn's patients, who require appropriate diagnostic and surveillance imaging at diagnosis and during symptomatic and asymptomatic recurrence, profit from this marginally invasive method [4].…”

Clinical guidelines. Crohn’s disease (К50), adults

“…• Спустя 6-12 месяцев после операции пациентам с БК рекомендовано проведение контрольного эндоскопического обследования, а при необходимости МРТ и/или КТ с контрастированием кишечника [200,205,206,207].…”

“…• Оперированным пациентам с БК, при невозможности визуализировать зону анастомоза рекомендовано констатировать наличие или отсутствие рецидива, основываясь на сочетании данных рентгенологического обследования (КТ и/или МРТ с контрастированием кишечника) и неинвазивных маркеров воспаления -СРБ, ФК и др. [200,206,207,208]. • Периодичность и объем диспансерного наблюдения определяется индивидуально, но у большинства пациентов рекомендовано выполнять исследование уровня С-реактивного белка в сыворотке крови, а также исследование уровня кальпротектина в кале каждые 3 месяца [74].…”

ACR Appropriateness Criteria® Crohn Disease-Child

“…Another potential indication for MRE is surveillance of asymptomatic patients with Crohn disease to assess subclinical disease activity. A study of 34 children and adolescents with asymptomatic Crohn disease patients undergoing MRE surveillance [52] found that several MRE imaging features (mural edema, hyperenhancement, engorged vasa recta, and restricted diffusion) were significant predictors of disease recurrence within 6 months, with sensitivity values of 71% to 86% and specificity values of 68% to 86%. Mural diffusion restriction was found to be the best predictor by multivariate regression and predicted future disease recurrence with an AUC of 0.786.…”