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Detecting inflammation in the unprepared pediatric colon - how reliable is magnetic resonance enterography?
Joy L Barber1, Adriana Chebar Lozinsky2, Fevronia Kiparissi2
1Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
Insights
MR enterography shows accuracy comparable to colonoscopy for assessing pediatric inflammatory bowel disease (IBD) in the colon. This imaging technique may aid in guiding biopsies and monitoring treatment for pediatric IBD patients.
Area of Science:
- Gastroenterology
- Radiology
- Pediatric Medicine
Background:
- Pediatric inflammatory bowel disease (IBD) commonly involves the colon.
- Magnetic resonance (MR) enterography is primarily used for small bowel assessment but also visualizes the colon.
Purpose of the Study:
- To compare the diagnostic accuracy of MR enterography with direct endoscopic visualization for evaluating the colon in pediatric IBD.
- To assess the utility of MR enterography in pediatric IBD colonic assessment.
Main Methods:
- Retrospective analysis of 15 children with IBD who underwent both MR enterography and endoscopy.
- Scoring colonic appearance on MR enterography using a total colon score.
- Comparison of MR enterography scores with endoscopic and histological findings.
Main Results:
- MR enterography colonic segmental scores showed 90% specificity and 60% sensitivity for predicting active inflammation on biopsy.
- Colonoscopy demonstrated 85% specificity and 53.3% sensitivity for detecting biopsy-proven inflammation.
- Accuracy of MR enterography was not significantly affected by bowel distension levels.
Conclusions:
- MR enterography scores exhibit comparable accuracy to colonoscopy for detecting biopsy-proven colonic inflammation in pediatric IBD.
- MR enterography may assist in biopsy guidance and monitoring treatment response in pediatric IBD.
- Colonic segment collapse did not hinder MR enterography's assessment of inflammation.
Background:
Pediatric inflammatory bowel disease frequently affects the colon. MR enterography is used to assess the small bowel but it also depicts the colon.
Objective:
To compare the accuracy of MR enterography and direct visualization at endoscopy in assessing the colon in pediatric inflammatory bowel disease.
Materials And Methods:
We included children with inflammatory bowel disease who had undergone both MR enterography and endoscopy, and we restrospectively assessed the imaging and endoscopic findings. We scored the colonic appearance at MR using a total colon score. We then compared scores for the whole colon and for its individual segments with endoscopy and histology.
Results:
We included 15 children. An elevated MR colonic segmental score predicted the presence of active inflammation on biopsy with a specificity of 90% (95% confidence interval [CI] 79.5-96.2%) and sensitivity of 60% (CI 40.6-77.3%); this compares reasonably with the predictive values for findings at colonoscopy - specificity 85% (CI 73.4-92.9%) and sensitivity 53.3% (CI 34.3%-71.6%). Accuracy did not change significantly with increasing bowel distension.
Conclusion:
MR-derived scores had comparable accuracy to those derived during visualization at colonoscopy for detecting biopsy-proven inflammation in our patient group. MR enterography might prove useful in guiding biopsy or monitoring treatment response. Collapse of a colonic segment did not impair assessment of inflammation.
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