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Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?
Zehour AlSabban1,2, Nicholas Carman3,4, Rahim Moineddin5
1Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.
Insights
Magnetic resonance enterography (MRE) can detect perianal disease (PAD) in pediatric inflammatory bowel disease (PIBD) with high specificity but moderate sensitivity. While effective for identifying PAD, MRE may miss some perianal fistulae and small perianal abscesses.
Area of Science:
- Radiology
- Gastroenterology
- Pediatrics
Background:
- Pediatric Crohn's disease frequently involves perianal disease (PAD).
- Magnetic resonance enterography (MRE) is used for small bowel assessment in pediatric inflammatory bowel disease (PIBD).
- Pelvic MRI (P-MRI) is the established standard for evaluating PAD.
Purpose of the Study:
- To evaluate the accuracy of MRE in detecting PAD in PIBD patients.
- To differentiate between perianal fistulae (PAF) and perianal abscesses (PAA) using MRE.
- To compare MRE findings against P-MRI as the reference standard.
Main Methods:
- A retrospective analysis of 77 PIBD patients who underwent both P-MRI and MRE within six months.
- Independent radiologist assessment of MRE and P-MRI for PAD, PAF, and PAA detection, followed by consensus review.
- Calculation of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MRE compared to P-MRI.
Main Results:
- MRE detected PAD in 73 patients, with high specificity (100%) but moderate sensitivity (82%).
- MRE showed 74% sensitivity and 71% specificity for PAF, and 51% sensitivity and 85% specificity for PAA.
- Interreader agreement for MRE in PAD detection was moderate (kappa=0.51).
Conclusions:
- MRE can accurately detect PAD in PIBD patients with high specificity.
- MRE may miss certain perianal fistulae and smaller perianal abscesses.
- MRE is a valuable tool for PAD assessment in PIBD, complementing P-MRI.
Background:
Pediatric Crohn's disease is associated with perianal disease (PAD). Magnetic resonance enterography (MRE) assesses small bowel involvement in pediatric inflammatory bowel disease (PIBD). Pelvic MRI (P-MRI) is the gold standard for assessing PAD.
Purpose:
To determine if MRE can accurately detect PAD in PIBD, distinguishing perianal fistulae (PAF) from perianal abscesses (PAA), referenced against P-MRI.
Study Type:
Retrospective.
Population:
Seventy-seven PIBD patients, 27 females (mean age 14.1 years), with P-MRI and MRE within 6 months.
Field Strength/Sequence:
1.5T and 3T; P-MRI: sagittal fat suppressed (FS) T2 fast spin-echo (FSE), coronal short tau inversion recovery, axial T1 FSE, coronal and axial postcontrast FS T1 FSE; MRE: coronal balanced steady-state free-precession (SSFP), coronal cine SSFP, coronal and axial single-shot T2 FS, axial SSFP, coronal ultrafast 3D T1 -weighted gradient echo FS (3D T1 GE), axial diffusion-weighted imaging, coronal and axial postcontrast 3D T1 GE FS.
Assessment:
Two radiologists independently, then by consensus, assessed randomized MRI exams, recording PAF number, location, and length; and PAA number, location, length, and volume. Sensitivity analysis used clinical disease as the gold standard, calculated separately for P-MRI and MRE.
Statistical Tests:
Comparing MRE and P-MRI consensus data, sensitivity, specificity, positive, and negative predictive values (P/NPV) were calculated. Inter- and intrareader reliability were assessed using kappa statistics.
Results:
P-MRI and MRE were paired, detecting PAD in 73 patients, PAF in 63, and PAA in 31 P-MRI. MRE sensitivities, specificities, PPV, and NPV were: PAD 82%, 100%, 100%, 23%; PAF 74%, 71%, 92%, 38%; PAA 51%, 85%, 69%, 72%; clinical 82%, 22%, 37%, 69%; clinical P-MRI 96%, 8%, 37%, 80%. MRE interreader agreement for PAD was moderate (kappa = 0.51 [0.29-0.73]), fair for PAF and PAA.
Data Conclusion:
Using a standard technique, MRE can detect PAD with high specificity and moderate sensitivity in PIBD, missing some PAF and small PAA.
Level Of Evidence:
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1638-1645.
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