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How we do it: MR enterography.

Mary-Louise C Greer1,2

  • 1Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada. mary-louise.greer@sickkids.ca.

Pediatric Radiology
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Summary
This summary is machine-generated.

Magnetic resonance enterography (MRE) is crucial for diagnosing pediatric inflammatory bowel disease (IBD). Optimized MRE protocols ensure accurate diagnosis and patient tolerance, with expanding applications in other intestinal conditions.

Keywords:
ChildrenCrohn diseaseMagnetic resonance enterographyMagnetic resonance imagingSmall bowel

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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.