Role of MR Enterography in Evaluation of Disease Activity in Pediatric Crohn’s Disease: Correlation between MR Enterography and Pediatric Crohn’s Disease Activity Index Scores

Abstract

Objectives The aim of the study was to assess the role of MR Enterography (MRE) in the diagnosis and follow-up of children with Crohn’s disease (CD) and to correlate disease activity indices with known MRE features of active disease. Methods This was a retrospective study including 24 patients (median age 11 years, 17 males) with clinically and histologically proven CD who underwent MRE. Two previously validated MRE scores—MR enterography global score (MEGS) and CD MRI index (CDMI)—were calculated. A correlative analysis was made between the Pediatric Crohn’s Disease Activity Index (PCDAI) score and MRE scores as well as individually with each MR variable. Comparison of both the MR scores was made between patients with different disease activity. Results MEGS and PCDAI scores showed strong positive correlation (r = 0.724, p = < 0.001); CDMI and PCDAI scores showed moderate positive correlation (r = 0.661, p = 0.0004). There was statistically significant difference in the MR scores between patients grouped by clinical activity. Among individual MR variables, mural thickness and enhancement best predicted the disease activity. Conclusions MRE-based scores and findings correlate with clinical activity in pediatric CD. Thereby, MRE can be considered a valuable tool in the management of CD, predicting disease activity and offering a potential alternative to endoscopy in monitoring patients during follow-up.

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].…”

“…This study revealed also a weak-to-moderate correlation between endoscopic findings and CDMI (R = 0.42; p < 0.05), although the endoscopic findings were evaluated with the help of a scoring system other than SES-CD [11]. 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].…”

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

“…Radhakrishnan et al showed MEGS had a strong positive correlation with PCDAI compared to CD MRI index score. (10) MEGS may provide an alternative to endoscopy in disease monitoring, showing good positive correlation with fecal calprotectin. (13) Components of MEGS are shown in table 3.…”

“…Radhakrishnan et al showed strong positive correlation between MRE scores and PCDAI, predicting disease activity non invasively akin to fecal calprotectin. (10) 3. Evaluation of response to medical treatment.…”

Introduction to the July Issue

“…The original article on magnetic resonance enterography (MRE) evaluation of disease activity in pediatric Crohn's disease by Radhakrishnan et al 6 shows good correlation between MRE-based score and pediatric Crohn's disease activity index (PCDAI) scores. Hence, MRE is valuable tool in management of Crohn's disease, predicting disease activity and offering a potential alternative to endoscopy in monitoring patient during follow-up.…”