How we do it: MR enterography

Area of Science:

• Radiology and Imaging
• Pediatric Gastroenterology

Background:

• Magnetic resonance enterography (MRE) is increasingly vital for diagnosing pediatric inflammatory bowel disease (IBD), including differentiating Crohn disease from ulcerative colitis.
• Its application is expanding to other pediatric intestinal pathologies like scleroderma.
• Optimizing MRE protocols for children and adolescents is essential for diagnostic accuracy, tolerability, and monitoring treatment response due to the lack of ionizing radiation.

Purpose of the Study:

• To review the role and optimization of MRE in pediatric IBD diagnosis and management.
• To highlight differences in pediatric MRE protocols compared to adult protocols.
• To discuss standard and advanced MRI sequences applicable in pediatric MRE.

Main Methods:

• Pediatric MRE protocols utilize weight-based dosing for oral/intravenous contrast and antispasmodics (hyoscine-N-butylbromide or glucagon).
• Standard and advanced MRI sequences, including balanced steady-state free precession, T2-weighted, diffusion-weighted imaging, and 3-D T1-weighted gradient echo sequences, are employed.
• Patient education is key to improving compliance.

Main Results:

• MRE effectively distinguishes between Crohn disease and ulcerative colitis, defining disease extent and severity.
• Nausea is more common with glucagon, but vomiting is infrequent (<10%) with either antispasmodic.
• Advanced techniques like magnetization transfer imaging and quantitative bowel assessment show potential but are not yet standard.

Conclusions:

• Optimized MRE is a well-tolerated and diagnostic tool for pediatric IBD, with potential for broader intestinal pathology assessment.
• Serial MRE is valuable for monitoring treatment response and complications in pediatric IBD.
• Further research into advanced sequences may enhance MRE's diagnostic capabilities in pediatric patients.