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Published on: December 15, 2017
Intestinal lesions in pediatric Crohn disease: comparative detectability among pulse sequences at MR enterography
Beomseok Sohn1, Myung-Joon Kim, Hong Koh
1Department of Radiology and Research Institute of Radiological Science, Severance Children's Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea.
Insights
Dynamic contrast-enhanced MR enterography sequences show high lesion detectability and correlate with active inflammation in pediatric Crohn disease. Motility imaging had the lowest lesion detection rate among tested sequences.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Medical Imaging
Background:
- MR enterography (MRE) protocols for pediatric Crohn disease lack standardization.
- Various MRE sequences exist, but optimal protocol selection remains unclear.
Purpose of the Study:
- To evaluate and compare the lesion detection rates of different MRE sequences in children with Crohn disease.
- To correlate MRE findings with the Pediatric Crohn's Disease Activity Index (PCDAI).
Main Methods:
- Children with confirmed Crohn disease underwent MRE, including SSFSE, motility imaging, DWI, and dynamic contrast-enhanced imaging.
- Lesion detectability for each sequence was graded, and findings were correlated with PCDAI scores.
Main Results:
- All sequences demonstrated high lesion detectability, with dynamic contrast-enhanced imaging (arterial, portal, delayed phases) showing the highest rates (92.7-95.1%).
- Motility imaging had the lowest lesion detection rate (78.1%), while DWI showed lower detectability than SSFSE.
- Higher PCDAI scores were significantly associated with lesions detected on dynamic contrast-enhanced imaging.
Conclusions:
- While all MRE sequences are effective, dynamic contrast-enhanced imaging is most sensitive for detecting active inflammation in pediatric Crohn disease.
- Motility imaging is less effective for lesion detection compared to other MRE sequences.
- Dynamic contrast-enhanced MRE findings correlate with disease activity, aiding in assessing inflammation severity.
Background:
Variable sequences can be used in MR enterography, and no consensus exists for the best protocol in children with Crohn disease.
Objective:
To compare the lesion detectability of various MR enterography sequences and to correlate the findings of these sequences with the Pediatric Crohn's Disease Activity Index (PCDAI) in children with Crohn disease.
Materials And Methods:
Children with clinically or pathologically confirmed Crohn disease underwent MR enterography, including a single-shot fast spin-echo (SSFSE) sequence, motility imaging (coronal 2-D balanced fast field echo), diffusion-weighted imaging (DWI), and dynamic contrast enhancement imaging (including arterial, portal and delayed phases). The lesion detectability of each sequence was graded 0-2 for each involved bowel segment. The lesion detectability and PCDAI result on different sequences were compared using the weighted least squares method and Student's t-test, respectively.
Results:
Fifteen children (11 boys, 4 girls, mean age 13.7 ± 1.4 years) with a total of 41 lesions were included in this study. All lesions detected in more than two sequences were visible on the single-shot fast spin-echo (SSFSE) sequence. The relative lesion detection rate was 78.1% on motility imaging, 90.2% on DWI, and 92.7% on arterial, 95.1% on portal and 95.1% on delayed phase imaging. Compared to the SSFSE sequence, motility imaging (P < 0.001) and DWI (P = 0.039) demonstrated lower detectability. The mean PCDAI result in the detected lesions was statistically higher only on dynamic enhancement imaging (P < 0.001).
Conclusion:
All MR enterography sequences were found to have relatively high lesion detectability in children with Crohn disease, while motility imaging showed the lowest lesion detectability. Lesions detected on dynamic enhancement imaging showed a higher PCDAI result, which suggests that this sequence is specific for active inflammation.
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