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MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image
Imad Absah1, David H Bruining, Jane M Matsumoto
1Division of Pediatric Gastroenterology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Insights
Magnetic resonance (MR) enterography is a feasible and effective imaging technique for pediatric patients with inflammatory bowel disease (IBD) aged 9 and older, demonstrating good performance without sedation.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Inflammatory bowel disease (IBD) diagnosis in children requires accurate imaging.
- MR enterography (MRE) offers a non-invasive imaging option for pediatric IBD assessment.
Purpose of the Study:
- To evaluate the image quality, oral contrast administration, bowel distention, side effects, and diagnostic performance of MRE in pediatric IBD patients.
- To assess the feasibility of MRE without sedation in this population.
Main Methods:
- Retrospective analysis of 85 MRE studies in 70 pediatric IBD patients (aged 9-18) performed without sedation.
- Assessment of image quality, bowel distention, and oral contrast intake.
- Correlation of MRE findings with endoscopic findings.
Main Results:
- Acceptable bowel distention achieved in 93% of studies.
- Mean image quality was higher for unenhanced than contrast-enhanced images.
- MRE demonstrated good sensitivity and specificity for detecting active enteric inflammation.
Conclusions:
- MRE is feasible and safe for pediatric IBD patients aged 9 and older without sedation.
- High image quality and diagnostic performance can be achieved.
- Oral contrast protocols can be age-adjusted, with minor adverse events reported.
Objective:
The purpose of this article was to evaluate image quality, oral contrast administration and bowel distention, side effects, and performance estimates of MR enterography in a large cohort of pediatric patients with inflammatory bowel disease (IBD).
Materials And Methods:
A retrospective analysis of the pediatric IBD clinic database (2007-2010) was performed. Eighty-five MR enterography studies in 70 patients were performed without sedation. All pediatric patients with the potential diagnosis of IBD were included, with the exception of studies performed on patients with ileoanal pouch anatomy. The quantity of ingested oral contrast material and number of adverse events were recorded. Retrospectively, image quality (including motion artifact and bowel distention) and enteric inflammation were assessed. Correlation between radiographic findings and endoscopic findings was tested by the Fisher exact test.
Results:
Eighty-five MR enterography studies were performed without sedation in 70 patients (mean age, 15.6 years; age range, 9-18 years) over 30 months. The mean image quality for unenhanced images was significantly higher than for contrast-enhanced images (4.7 vs 4.1, p < 0.0001), with unacceptable image quality occurring on both unenhanced and contrast-enhanced sequences in one patient. The amount of oral contrast material ingested correlated with patient age (p = 0.009), with acceptable bowel distention occurring in 93% (78/85). Two patients had nausea or emesis and one experienced a syncopal episode after MR enterography. Sensitivity and specificity of MR enterography for active disease of the terminal ileum, right colon, and left colon were 80% and 85.2%, 79.1% and 77.8%, and 90.3% and 63.6%, respectively.
Conclusion:
MR enterography is feasible in patients 9 years old and older without sedation. Acceptable image quality can be achieved in nearly all patients, but a small minority will have suboptimal bowel distention or minor adverse events. Oral contrast ingestion regimes can be based on patient age. Performance estimates in children parallel reports in adults.
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