Quantitative assessment of terminal ileum motility on MR enterography in Crohn disease: a feasibility study in children

Abstract

Purpose: To investigate the relationship between software quantified terminal ileal (TI) motility and histopathological activity grading, a standardised MRI activity score Crohns Disease MRI Index (CDMI) and faecal calprotectin.Methods: A review of a tertiary referral paediatric hospital imaging database was performed to identify subjects with Crohns disease or unclassified inflammatory bowel disease (IBDU) who underwent dynamic MRI Enterography (MRE) bowel motility assessment. Dynamic imaging for 25 patients (median age 12, range 5 to 16) was analysed, blind to any clinical data, with a previously validated motility assessment algorithm (GIQuant®, Motilent, London, UK).A region of interest was placed in the terminal ileum (TI) within 3cm of the ileocecal valve and the motility score derived. The primary SoR was TI histopathological Endoscopic biopsy Assessment of Inflammatory Activity (eAIS) occurring within 40 days of the MRI. Our secondary SoRs were: 1) the Crohns Disease MRI Index (CDMI), a standardised MRI activity score validated against eAIS and 2) faecal calprotectin (FC) levels within 3 months of MRE.Results: MR Enterography derived median motility score was 0.17 (interquartile range, IQR 0.12 to 0.25) and median CDMI was 3 (IQR 0 to 5.5). Based on the primary SoR, 43% of patients had active disease (eAIS>0) with the median eAIS score of 0 (IQR 0 to 2; range 0 to 5).Correlation between eAIS and motility was r = -0.58 (p = 0.004, N = 23) and between CDMI and motility was r = -0.42 (p = 0.037, N = 25). Motility score was lower in those with active disease (median 0.12 vs 0.21, p = 0.020) while CDMI was higher (median 5 vs 1, p = 0.04). In a subset of 12 patients with faecal calprotectin within 3 months of MRE, correlation between and motility was r = -0.27 (p = 0.4). Conclusion:Quantified terminal ileal motility is significantly negatively correlated with histopathological activity, reproducing findings in adult populations. TI motility also shows a

A review of magnetic resonance enterography based Crohn’s disease activity indices in paediatric patients

“…Four MRE scoring systems were reviewed: the Magnetic Resonance Index of Activity (MARIA), the Crohn's Disease Magnetic Resonance Imaging Index (CDMI), the Magnetic Resonance Enterography Global Score (MEGS), and the Visual Analogue Scale (VAS). The MARIA, MEGS, and VAS were evaluated against the SES-CD (Table I) [7][8][9][10][11][12][13][14][15][16].…”

“…The correlation between CDMI and PCDAI was estimated in 2 studies, and their results were similar: (R = 0.661; p = 0.0004) and (R = 0.656; p < 0.01) [11,12]. Cococcioni et al showed a negative correlation between terminal ileum motility and CDMI [13]. Despite its simplicity, CDMI requires peroral preparation and contrast administration.…”

Intestinal strictures in Crohn’s disease: a 2021 update

“… 62 Terminal ileum motility was found to be negatively associated with CD activity, which might be a candidate biomarker for monitoring disease progression and treatment efficacy. 62 , 63 …”

“…In addition, MR enterography was first used to measure terminal ileum motility in pediatric CD patients with standard freebreathing techniques in 2021. 62 Terminal ileum motility was found to be negatively associated with CD activity, which might be a candidate biomarker for monitoring disease progression and treatment efficacy. 62,63 Radiomics is a popular form of radiologic imaging analysis aiming to extract high-dimensional imaging features to reveal subtle disease characteristics.…”

“…62 Terminal ileum motility was found to be negatively associated with CD activity, which might be a candidate biomarker for monitoring disease progression and treatment efficacy. 62,63 Radiomics is a popular form of radiologic imaging analysis aiming to extract high-dimensional imaging features to reveal subtle disease characteristics. 64 Li et al 49 developed a novel CTE-based RM to assess intestinal fibrosis in CD patients, which substantially improved the quantitation of CTE in intestinal fibrosis.…”