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Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease.

ABSTRACT: Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

SUBMITTER: Masselli G

PROVIDER: S-EPMC4965351 | biostudies-literature | 2016 Jul

REPOSITORIES: biostudies-literature

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Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease.

Masselli Gabriele G Mastroiacovo Ilaria I De Marco Emidio E Francione Giulia G Casciani Emanuele E Polettini Elisabetta E Gualdi Gianfranco G

World journal of radiology 20160701 7

Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the co ...[more]

PMID: 27551337

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Project description:BackgroundThis study aimed to construct a magnetic resonance imaging (MRI) index for assessing transmural inflammatory activity in the small intestine of patients with Crohn' disease which enables rapid and non-invasive quantitative assessment of Crohn's disease inflammation.MethodsIn this prospective study, magnetic resonance enterography (MRE) was performed to examine 29 consecutive patients with Crohn's disease who had undergone ileocolonoscopy in the Jingling hospital of Nanjing. This diagnostic study was not registered on a clinical trial platform. We grade the T2 signal ratio and T1 enhancement ratio with a score of 0 to 3. The ratios were calculated as follow: terminal ileal inflammation of intestinal T2 signal intensity/adjacent normal intestinal T2 signal intensity (T2 ratio 1), terminal ileal inflammation intestinal T2 signal intensity/vertical muscle T2 signal intensity (T2 ratio 2), the fifth phase of the inflamed intestinal T1 signal intensity/noncontrast intestine T1 signal (T1 ratio 3), and the fifth phase of inflamed intestinal T1 signal intensity/adjacent normal intestinal T1 signal (T1 ratio 4). Wall thickness, lymph nodes, perimural T2 signal, comb sign, and ulceration were graded from 0 to 3. the simple endoscopic score for Crohn's disease (SES-CD) from 0 to 12 was used to assess Crohn's disease activity as a reference. The study calculated the correlations between the MRE activity index and endoscopic activity scores and derived the MRE index model to assess Crohn's disease activity.ResultsThe MRE index model (a T1 ratio 4 score of 1.52 + an ulceration score of 2.03) had a sensitivity of 0.962, a specificity of 0.667, and an area under the curve (AUC) of 0.968 [95% confidence interval (CI): 0.921-1.000]. The intraclass correlation coefficient (ICC) for the interobserver agreement of the MRE index was 0.921 (95% CI: 0.833-0.963).ConclusionsThe study derived an MRE index with good sensitivity to inflammatory changes in the small bowel. The index could be used to assess Crohn's disease activity of the small bowel.

Project description:ObjectivesTo compare patient acceptability and burden of magnetic resonance enterography (MRE) and ultrasound (US) to each other, and to other enteric investigations, particularly colonoscopy.Methods159 patients (mean age 38, 94 female) with newly diagnosed or relapsing Crohn's disease, prospectively recruited to a multicentre diagnostic accuracy study comparing MRE and US completed an experience questionnaire on the burden and acceptability of small bowel investigations between December 2013 and September 2016. Acceptability, recovery time, scan burden and willingness to repeat the test were analysed using the Wilcoxon signed rank and McNemar tests; and group differences in scan burden with Mann-Whitney U and Kruskal-Wallis tests.ResultsOverall, 128 (88%) patients rated MRE as very or fairly acceptable, lower than US (144, 99%; p < 0.001), but greater than colonoscopy (60, 60%; p < 0.001). MRE recovery time was longer than US (p < 0.001), but shorter than colonoscopy (p < 0.001). Patients were less willing to undergo MRE again than US (127 vs. 133, 91% vs. 99%; p = 0.012), but more willing than for colonoscopy (68, 75%; p = 0.017). MRE generated greater burden than US (p < 0.001), although burden scores were low. Younger age and emotional distress were associated with greater MRE and US burden. Higher MRE discomfort was associated with patient preference for US (p = 0.053). Patients rated test accuracy as more important than scan discomfort.ConclusionsMRE and US are well tolerated. Although MRE generates greater burden, longer recovery and is less preferred than US, it is more acceptable than colonoscopy. Patients, however, place greater emphasis on diagnostic accuracy than burden.Key points• MRE and US are rated as acceptable by most patients and superior to colonoscopy. • MRE generates significantly greater burden and longer recovery times than US, particularly in younger patients and those with high levels of emotional distress. • Most patients prefer the experience of undergoing US than MRE; however, patients rate test accuracy as more importance than scan burden.

Dataset Information

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease.

Publications

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn's disease.

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