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Fluorescence-mediated Tomography for the Detection and Quantification of Macrophage-related Murine Intestinal Inflammation
Published on: December 15, 2017
[MRI enterography in the assessment of paediatric Crohn's disease]
M Alvarez Beltran1, I Barber Martinez de la Torre, O Segarra Cantón
1Unidad de Gastroenterología, Hepatología y Nutrición Pediátrica, Servicio de Pediatría, Hospital Universitari Vall d'Hebron, Barcelona, Spain. : alvarezbeltran@hotmail.com
Insights
MRI enterography is useful for assessing pediatric Crohn's disease activity and extent. This imaging technique correlates well with clinical markers and allows for non-irradiating diagnosis of complications.
Area of Science:
- Gastroenterology
- Pediatric Radiology
- Medical Imaging
Context:
- Pediatric Crohn's disease (PCD) requires accurate assessment of disease activity and extent.
- Conventional methods may have limitations in evaluating disease extension and complications.
- MRI enterography offers a non-invasive imaging modality for evaluating the gastrointestinal tract.
Purpose:
- To evaluate the utility of MRI enterography in assessing the extension and activity of pediatric Crohn's disease.
- To compare MRI findings with clinical, biological, endoscopic, and histological data.
- To define MRI patterns indicative of disease activity and complications.
Summary:
- Twenty-two studies were reviewed, demonstrating optimal intestinal distension in 82% of cases with mild side effects in 12%.
- MRI enterography showed significant correlations between disease patterns and Pediatric Crohn's Disease Activity Index (PCDAI) scores, sedimentation rate, and C-reactive protein (PCR) levels.
- The technique accurately assessed ileal (80%) and colonic (66%) extension and identified extra-luminal complications in 86.4% of studies.
Impact:
- MRI enterography demonstrates significant relationships with key clinical and biological markers of inflammation in pediatric Crohn's disease.
- It provides excellent agreement with ileoscopies and assesses areas inaccessible to endoscopy.
- This modality enables the diagnosis of extra-luminal complications without the need for ionizing radiation.
Objective:
To determine the usefulness of MRI enterography for assessing the extension and activity of paediatric Crohn's disease. MRI findings were compared with clinical, biological, endoscopic and other imaging data.
Patients And Methods:
Studies of MRI enterography use in patients younger than 18 years of age were reviewed. Patients received 500-1000mL of polyethylene glycol one hour before examination (1.5-TMR). T2 HASTE sequences with or without fat saturation, T2 true-FISP, T1 with fat saturation, pre- and post gadolinium-enhanced VIBE sequences, and dynamic and diffusion HASTE were acquired. Thickening of the bowel wall, mucosal enhancement, and extra-luminal complications were evaluated. Five MRI patterns (normal, fibrosis, mild, moderate, and severe transmural activity) were defined. Findings were compared with PCDAI scores, inflammatory parameters, and endoscopic and histological results.
Results:
Twenty-two studies were reviewed. Optimal intestinal distension was present in 82% of the cases. Mild side effects were observed in 12% of patients. There was a significant relationship between MRI patterns and PCDAI scores (P=.002), sedimentation rate (P=.006) and serum PCR levels (P=.047) and a non-significant relationship with the histology (P=.571). MRI enterography correctly assessed the ileal (80%) and colonic (66%) extension. Extra-luminal complications unrelated to MRI classification (P=.274) were reported in 86.4% of studies.
Conclusions:
There was a significant relationship between MRI patterns and PCR, sedimentation rate, and PCDAI scores. MRI enterography showed excellent agreement with ileoscopies, and allowed endoscopically non-accessible areas to be assessed, as well as the diagnosis of extra-luminal complications without irradiation.
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