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Quantitative evaluation of Crohn's disease using dynamic contrast-enhanced MRI in children and young adults
Seunghyun Lee1, Young Hun Choi2,3, Yeon Jin Cho1
1Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Insights
Dynamic contrast-enhanced MRI (DCE-MRI) quantitatively assesses Crohn's disease activity in pediatric patients. The Ktrans value from DCE-MRI effectively distinguishes active from inactive Crohn's disease, aiding in monitoring and management.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease is a chronic inflammatory condition affecting children and young adults.
- Accurate assessment of disease activity is crucial for effective management.
- Existing methods for assessing disease activity have limitations.
Purpose of the Study:
- To evaluate the clinical usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing Crohn's disease activity in pediatric patients.
- To determine if DCE-MRI perfusion parameters can differentiate between active and inactive disease.
Main Methods:
- 30 pediatric patients with Crohn's disease underwent DCE-MRI with MRI enterography.
- Disease activity was assessed using endoscopic findings, Pediatric Crohn's Disease Activity Index (PCDAI), C-reactive protein (CRP) levels, and Crohn's Disease MR Index (CDMI).
- DCE-MRI perfusion parameters (Ktrans, Kep, Ve) were analyzed at the ileocecal region.
Main Results:
- Active Crohn's disease patients exhibited higher PCDAI, CRP, and CDMI scores compared to inactive patients.
- The Ktrans value was significantly higher in the active Crohn's disease group.
- Endoscopic findings, PCDAI, CRP, CDMI, and Ktrans were significant parameters for identifying active disease.
Conclusions:
- The Ktrans value derived from DCE-MRI is a significant parameter for differentiating between inactive and active Crohn's disease in pediatric patients.
- DCE-MRI, particularly the Ktrans value, shows potential for quantitatively monitoring pediatric Crohn's disease activity and informing clinical management.
Objectives:
To evaluate the clinical usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in children and young adults with Crohn's disease.
Methods:
From August 2017 to October 2018, 30 patients with Crohn's disease (21 males and 9 females; mean age 15.1 ± 2.5 years) underwent DCE-MRI with MRI enterography. We assessed the endoscopic finding, pediatric Crohn's disease activity index (PCDAI), C-reactive protein (CRP) level (mg/dL), Crohn's disease MR index (CDMI) score, and the perfusion parameters of DCE-MRI (Ktrans, Kep, and Ve) at the ileocecal region between the inactive and active groups based on the histopathologic status.
Results:
The active Crohn's disease group showed higher PCDAI, CRP, and CDMI scores than the inactive group (22.2 ± 18.8 vs. 6.3 ± 6.4, p = 0.027; 1.32 ± 1.79 vs. 0.10 ± 0.13, p = 0.005; 7.4 ± 3.9 vs. 4.5 ± 3.0, p = 0.047, respectively). The active Crohn's disease group showed a higher Ktrans value than the inactive group (0.31 ± 0.12 vs. 0.16 ± 0.46 min-1, p = 0.002). Endoscopic finding; PCDAI, CRP, and CDMI scores; and Ktrans value were significant parameters in the identification of the active Crohn's disease (p = 0.002, p < 0.001, p = 0.029, p = 0.006, and p < 0.001, respectively). Ktrans value was the most significant value for identifying active Crohn's disease in the multivariate logistic regression analysis (p = 0.013).
Conclusion:
Ktrans value could discriminate between inactive and active Crohn's diseases. Ktrans value may have the potential to monitor the pediatric Crohn's disease activity.
Key Points:
• With dynamic contrast-enhanced MRI, we can quantitatively monitor the Crohn's disease status in pediatric patients and provide proper management plans to clinicians. • The Ktransvalue of dynamic contrast-enhanced MRI perfusion parameter, as well as the clinical pediatric Crohn's disease activity index, C-reactive protein level, the endoscopic score, and the Crohn's disease MR index, was higher in the active Crohn's disease than in the inactive group based on the histopathologic status. • The Ktransvalue among the dynamic contrast-enhanced MRI perfusion parameters was the most significant differentiating parameter for the active Crohn's disease from inactive status among those parameters (p = 0.013).
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