Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

Rosenbaum, Daniel G.; Conrad, Máire A.; Biko, David M.; Ruchelli, Eduardo D.; Kelsen, Judith R.; Anupindi, Sudha A.

doi:10.1007/s00247-016-3704-x

Cited by 23 publications

(11 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2008, a meta-analysis by Horsthuis et al [8] showed no significant difference in the diagnostic accuracy using magnetic resonance imaging (MRI), CT, or US in evaluating patients with IBD. Although it has been difficult to replicate these data, multiple studies have shown excellent sensitivity and specificity for US compared with other readily available cross-sectional imaging techniques in North America while identifying some advantages and disadvantages of its use [9][10][11][12][13][14][15]. US is particularly effective in the management of Crohn's disease for diagnosis and monitoring treatment response and complications such as stenosis, abscesses, and fistulae [16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

View full text Add to dashboard Cite

Background: Inflammatory bowel disease (IBD) is a chronic relapsing disease that requires evaluation using multiple objective tools. In Europe, bowel ultrasound (US) is a widely accepted modality used for the management of patients with IBD; however, its use in North America has only recently emerged as a potential technique. Objectives: Our goal was to identify current practice patterns of pediatric gastroenterologists and radiologists using bowel US in patients with IBD and highlight perceived limitations to the widespread adoption of this modality in North America. Methods: A 14-question survey was e-mailed to the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition internet bulletin board composed of 3,058 subscribers from 51 countries; the Society of Pediatric Radiology listserv composed of 1,917 subscribers worldwide; and the Society of Chairs of Radiology at Children's Hospitals listserv. Descriptive summary statistics was used. Results: In North America, about one-quarter of gastroenterology and radiology participants reported using bowel US for IBD; over 3-fourths expressed an interest in using US more often. Bowel US was performed more frequently for Crohn's disease. Both groups agreed the main limitation to using bowel US was concern for inter-observer variability and operator-dependent factors; radiologists reported that other modalities are more effective to assess IBD, whereas gastroenterologists reported unfamiliarity with bowel US indications and techniques. Conclusions: Our data show there is significant interest among both radiologists and gastroenterologists in using bowel US. However, lack of education, insufficient training, and perceived high inter-observer variability among US technologists are limitations preventing the widespread adoption of US for IBD in North America.

show abstract

Section: Introductionmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

View full text Add to dashboard Cite

show abstract

“…We know that there are different phenotypes of CD and that some patients may present a more rapid evolution towards intestinal fibrosis than others [1,7,26]. Therefore, in our opinion, future research should focus on the application of "omic" sciences.…”

Section: Discussionmentioning

confidence: 98%

“…However, in order to limit the possibility of bias, unlike recent prospective reports [13,19,20,22], we analyzed only one ileal segment per patient. Moreover, unlike previous retrospective studies [1,26], in which MR systems with different field strengths (1.5-and 3.0-tesla) were used, our MRI scanner remained the same for the entire duration of the study and the MRE imaging protocol did not undergo modifications, DWI sequences being present from the beginning. The second limitation, the small number of patients, is due to our reference standard, full-thickness histopathological specimens, closely linked to a limited subgroup of patients needing surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?

Foti¹,

Travali²,

Farina³

et al. 2021

Medicina

View full text Add to dashboard Cite

Background and Objectives: To retrospectively assess the value of magnetic resonance enterography (MRE) parameters derived from conventional and diffusion weighted imaging (DWI) sequences to differentiate fibrotic strictures from inflammatory ones in adult patients with Crohn’s disease (CD), using surgical specimens as the histopathological reference standard. Material and Methods: Twenty-three patients with CD who had undergone surgical resection of ileal strictures with full-thickness histopathologic analysis within 3 months from preoperative MRE were included. Two radiologists blinded to histopathology in consensus evaluated the following biomarkers on MRE images matched to resected pathological specimens: T1 ratio, T2 ratio, enhancement pattern, mural thickness, pre-stenotic luminal diameter, and apparent diffusion coefficient (ADC). A blinded pathologist graded stricture histological specimens with acute inflammation score (AIS) and fibrosis score (FS). MRE measurements were correlated with the reference standard. Results: Inflammation and fibrosis coexisted in 78.3% of patients. T2 ratio was reduced in patients with severe fibrosis (p = 0.01). Pre-stenotic bowel dilatation positively correlated with FS (p = 0.002). The ADC value negatively correlated with FS (p < 0.001) and was different between FS grades (p < 0.05). The area under the receiver operating characteristic curve for discriminating between none and mild/moderate–severe bowel wall fibrosis was 0.75 for pre-stenotic bowel dilatation (sensitivity 100%, specificity 44.4%) and 0.97 for ADC (sensitivity 80%, specificity 100%). Conclusions: Inflammation and fibrosis often coexist in CD bowel strictures needing surgery. The combination of parameters derived from conventional MR sequences (T2 ratio, pre-stenotic dilatation) and from DWI (ADC) may provide a contribution to detect and grade bowel fibrosis in adult CD patients.

show abstract

“…10 Mesenteric oedema is a common imaging feature of the mesentery in CD that reflects severe intestinal inflammation or might be used as a predictor for bowel resection. 32,33 Given that intestinal inflammation always coexists with bowel fibrosis, especially in CD patients with long disease courses, mesenteric oedema and disease course might be able to indirectly suggest the presence of moderate-tosevere intestinal fibrosis. 12,25 Our study had some limitations.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn’s disease: a computed tomography and clinical marker-based nomogram

Meng

Mao

Zhou

et al. 2022

Therap Adv Gastroenterol

View full text Add to dashboard Cite

Background: While the grading of intestinal fibrosis is closely related to the therapeutic strategy of patients with Crohn’s disease (CD), it has not yet been well resolved. Mesenteric abnormalities are inextricably linked to intestinal fibrosis. Objectives: We aimed to establish an optimal model for assessing intestinal fibrosis using computed tomography enterography (CTE) and clinical markers. Design: A total of 174 patients with CD between January 2014 and June 2020 were included in this retrospective multicentre study. Methods: All patients underwent CTE within 3 months prior to surgery. Intestinal fibrosis was pathologically scored as non-mild or moderate-to-severe. Selected imaging of the intestinal walls and mesentery and/or clinical factors were used to develop the diagnostic models. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the discrimination performance of the models. A decision curve analysis was performed to evaluate the clinical usefulness of the models. Results: One-, two-, and three-variable models were identified as possible diagnostic models. Model 1 [mesenteric creeping fat index (MCFI)], Model 2 (mesenteric oedema and MCFI), and Model 3 (mesenteric oedema, MCFI, and disease duration) were established. The AUCs of Model 1 in training and test cohorts 1 and 2 were 0.799, 0.859, and 0.693, respectively; Model 2 was 0.851, 0.833, and 0.757, respectively; and Model 3 was 0.832, 0.821, and 0.850, respectively. We did not observe any significant difference in diagnostic performance between the training and total test cohorts in any model (all p > 0.05). The decision curves showed that Model 3 had the highest net clinical benefit in test cohort 2. The nomogram of this optimal model was constructed by considering the favourable and robust performance of Model 3. Conclusion: A nomogram integrating mesenteric abnormalities on CTE with a clinical marker was optimal for differentiating between non-mild and moderate-to-severe fibrosis in patients with CD.

show abstract

Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

Cited by 23 publications

References 40 publications

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Can Conventional and Diffusion-Weighted MR Enterography Biomarkers Differentiate Inflammatory from Fibrotic Strictures in Crohn’s Disease?

Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn’s disease: a computed tomography and clinical marker-based nomogram

Contact Info

Product

Resources

About