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MRI reveals different Crohn's disease phenotypes in children and adults
Francesca Maccioni1, Davide Bencardino2, Valeria Buonocore2
1Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Policlinico Umberto I Hospital , Viale del Policlinico, 155, 00161, Rome, Italy. francesca.maccioni@uniroma1.it.
Objectives:
To identify differences between two cohorts of adult and pediatric patients affected by Crohn's disease (CD), with regard to lesion location in the small intestine and colon-rectum, lesion activity, and prevalence of perianal disease (PD), using MRI as the main diagnostic tool.
Methods:
We retrospectively reviewed 350 consecutive MRI examinations performed between 2013 and 2016 in outpatients or inpatients with histologically proven CD, monitored by the Gastroenterology and Pediatric Units of our Hospital. The magnetic resonance enterography (MRE) protocol for adult and pediatric CD patients routinely includes evaluation of nine different intestinal segments (from jejunum to rectum) and of the anal canal. Intestinal activity was also calculated using a validated score. Perianal disease (PD) was staged. Fisher's exact test was used and the odds ratio (OR) was calculated.
Results:
Two hundred and nineteen out of 350 MRI studies (118 adults and 101 children) were included. The prevalence of PD was 34.6% in children and 16.1% in adults (OR = 2.8; p = 0.0017). Pediatric patients showed more frequent rectal involvement (29.7% vs 13.5%, OR = 2.7; p = 0.0045) and higher risk of PD in the presence of rectal disease (p = 0.043; OR = 4.5). In pediatric patients with severe colorectal disease, the prevalence of PD was twofold (86.7% vs 40%; p = 0.072). Using the clinical Montreal classification for lesion location, no significant differences emerged between the two patient populations.
Conclusions:
MRI showed a significantly higher prevalence of rectal involvement and perianal disease in the pediatric population. These results may have a relevant clinical impact and deserve further investigation.
Key Points:
• To our knowledge, this is the largest morphological comparative study available in the literature using MRI as the main diagnostic tool to compare adult patients and children with Crohn's disease. • Our study showed significant differences between adults and children: a higher prevalence of rectal and perianal fistulous disease (PD) in pediatric patients and an increased prevalence of PD in the presence of severe colon-rectum involvement. • The association of rectal and perianal disease implies a poorer clinical prognosis and a higher risk of disabling complications in pediatric patients.
Insights
Pediatric Crohn's disease (CD) patients show significantly higher rates of rectal and perianal disease (PD) compared to adults. This highlights potential differences in disease presentation and prognosis between pediatric and adult CD populations.
Area of Science:
- Gastroenterology
- Radiology
- Pediatric Medicine
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease affecting both adults and children.
- Understanding differences in disease presentation between pediatric and adult CD cohorts is crucial for tailored management.
- Magnetic Resonance Imaging (MRI) is a key diagnostic tool for evaluating CD.
Purpose of the Study:
- To compare lesion location, activity, and perianal disease (PD) prevalence in adult versus pediatric CD patients.
- To utilize MRI as the primary diagnostic modality for this comparison.
- To identify potential differences in disease manifestation between age groups.
Main Methods:
- Retrospective review of 350 consecutive MRI examinations (2013-2016) in CD patients.
- Inclusion of both adult and pediatric patients with histologically proven CD.
- Standardized MRI protocol evaluating nine intestinal segments and the anal canal, with activity scoring and PD staging.
Main Results:
- 118 adults and 101 children included in the analysis.
- Pediatric patients had a significantly higher prevalence of PD (34.6% vs 16.1%) and rectal involvement (29.7% vs 13.5%).
- Pediatric patients with severe colorectal disease showed a twofold higher prevalence of PD.
Conclusions:
- MRI reveals a significantly higher prevalence of rectal and perianal disease in pediatric CD patients.
- The association of rectal and perianal disease in children suggests a potentially poorer prognosis and higher risk of complications.
- These findings underscore the need for further investigation into pediatric CD management strategies.
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