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[Value of contrast-enhanced MR enterography in pediatric Crohn's disease: preliminary study]
C Godefroy1, F Pilleul, F Dugougeat
1Service de Radiologie Pédiatrique, Hôpital Edouard Herriot, Lyon.
Insights
Magnetic resonance (MR) enterography without enteroclysis is a feasible and effective non-invasive tool for diagnosing pediatric Crohn's disease. This method offers high diagnostic accuracy without ionizing radiation, making it ideal for children.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Diagnostic Imaging
Background:
- Crohn's disease diagnosis in children often requires invasive procedures.
- Non-invasive imaging modalities are crucial for pediatric patients.
- Magnetic resonance (MR) enterography offers a radiation-free alternative.
Purpose of the Study:
- To assess the feasibility of MR enterography without enteroclysis for diagnosing pediatric Crohn's disease.
- To evaluate the diagnostic performance and image quality of this technique.
- To establish MR enterography as a potential gold standard in pediatric care.
Main Methods:
- Prospective study of 15 children (8-18 years) with suspected Crohn's disease.
- MR enterography performed on a 1.5 T system with oral mannitol for bowel distension.
- Image analysis by two blinded radiologists for quality, distension, abnormalities, and extra-intestinal complications; findings correlated with other diagnostic methods.
Main Results:
- Satisfactory diagnostic quality achieved in 93.3% of examinations.
- Good to excellent distal ileum distension in 89% of subjects.
- 100% sensitivity and 83% specificity for Crohn's disease diagnosis; detected ileo-ileal fistula, anal fistula, and inflammatory stricture.
Conclusions:
- MR enterography without enteroclysis is well-tolerated and effective for evaluating pediatric Crohn's disease.
- The absence of ionizing radiation supports its use as a preferred method in children.
- This technique demonstrates high diagnostic accuracy and identifies key disease manifestations.
Objective:
Feasibility study of contrast enhanced MR enterography without enteroclysis as a new diagnostic tool for children with known or suspected Crohn's disease.
Methods:
We prospectively included 15 children, 8-18 years old, with clinical suspicion of Crohn's disease. MR enterography without enteroclysis was performed on a 1,5 T clinical MR system. A total of 1000 ml of mannitol 5% was orally administered 60 minutes prior to MRI. Coronal and axial breath-hold sequences were acquired. The following sequences were obtained: True-FISP, FLASH T1 2D/3D with Fat saturation before and after gadolinium injection. Two radiologists, blinded to patient information, independently reviewed all examinations to record image quality, the degree of distension of the distal ileum, the presence of abnormal bowel segments and the presence of extra-intestinal complications. MRI findings were correlated to sonographic, endoscopic and biological results (sensitivity, specificity, Kappa test).
Results:
The examinations were considered of satisfactory diagnostic quality in 93.3% of patients. Respiratory artifacts were present in one case. The entire GI tract could be identified on all sequences. Distention of the distal ileum was recorded as good to excellent in 89% of healthy subjects. Five MR examinations were considered abnormal with isolated ileal involvement in 2 cases, ileocolic involvement in 2 cases, and isolated colonic involvement in 1 case. The sensitivity and specificity of MR for the positive diagnosis of Crohn's disease were 100% and 83% respectively. Three extra-intestinal complications were detected: one case of ileo-ileal fistula, not identified on ultrasonography, an asymptomatic anal fistula and a symptomatic inflammatory stricture.
Conclusion:
MR enterography without enteroclysis is a well tolerated, effective non invasive method in the evaluation of known or suspected Crohn's disease. Because of the absence of ionizing radiation, MR enterography should become the gold standard in pediatric patients.
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