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Fluorescence-mediated Tomography for the Detection and Quantification of Macrophage-related Murine Intestinal Inflammation
Published on: December 15, 2017
MR enterography to evaluate sub-clinical intestinal inflammation in children with spondyloarthritis
Matthew L Stoll1, Ashish S Patel, Marilynn Punaro
1UT Southwestern Medical Center/Department of Pediatrics/5323 Harry Hines Boulevard/Dallas, TX 75390-9063, USA. MStoll@peds.uab.edu.
Insights
Magnetic resonance enterography (MRE) can detect subclinical inflammatory bowel disease (IBD) in children with juvenile idiopathic arthritis (JIA). This safe and well-tolerated imaging technique identified mild intestinal inflammation in three out of five pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Immunology
Background:
- Magnetic resonance enterography (MRE) is an established tool for evaluating inflammatory bowel disease (IBD).
- Its utility in subclinical IBD, particularly in children with spondyloarthritis (SpA) at risk for gut inflammation, remains understudied.
- Children with juvenile idiopathic arthritis (JIA) often have an increased risk of developing subclinical gut inflammation.
Purpose of the Study:
- To evaluate the effectiveness of MRE in detecting subclinical IBD in children diagnosed with JIA.
- To assess the safety and tolerability of the MRE protocol in this pediatric population.
Main Methods:
- Children with JIA and elevated fecal calprotectin levels underwent MRE.
- Oral contrast (polyethylene glycol 3350) and glucagon for peristalsis arrest were utilized.
- Imaging was performed on a 1.5 T scanner using T2-weighted and post-gadolinium T1-weighted sequences.
Main Results:
- Five children with JIA (four with SpA, one with polyarticular JIA) completed the MRE.
- Three MRE studies showed findings suggestive of IBD, including terminal ileum (TI) changes and mesenteric lymphadenopathy.
- One child with TI inflammatory changes on MRE was diagnosed with IBD via colonoscopy.
Conclusions:
- MRE is a viable and safe imaging modality for evaluating subclinical IBD in pediatric patients with JIA.
- The MRE protocol used was well-tolerated and successfully identified mild inflammatory changes in a subset of participants.
- MRE can aid in the early detection of gut inflammation in at-risk pediatric populations.
Background:
Magnetic resonance enterography (MRE) is an established tool to evaluate for changes associated with inflammatory bowel disease (IBD), but has not been studied in sub-clinical IBD. We sought to evaluate the use of MRE in children with spondyloarthritis (SpA), who are at risk of having sub-clinical gut inflammation.
Methods:
Children with juvenile idiopathic arthritis (JIA) with evidence of intestinal inflammation as evidence by an abnormal fecal calprotectin assay were offered MRE of their intestines. Flavored sports drink containing polyethylene glycol 3350 was used as oral contrast. Glucagon was used to arrest peristalsis. Patients were imaged in the prone position on a 1.5 T scanner. Heavily T2-weighted fat-suppressed coronal and axial images using breath-hold technique were obtained, followed by post-gadolinium fat-suppressed T1-weighted gradient echo images.
Results:
We recruited five children with juvenile idiopathic arthritis (JIA); four had SpA, and one had poly-articular JIA. All five had evidence of intestinal inflammation based upon a positive fecal calprotectin assay and successfully completed the MRE. Three of the studies showed findings suggestive of IBD, including thickening and contrast uptake at the terminal ileum (TI) in one child, contrast uptake of the distal ileum in another, and prominent vasa recta and mesenteric lymph nodes in the third. The child with evidence of inflammatory changes at the TI underwent colonoscopy, which revealed inflammatory bowel disease limited to the TI.
Conclusions:
MRE can be used to evaluate for subclinical IBD in children with JIA. This protocol was safe and well-tolerated, and identified mild changes in three of the subjects.
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