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Development and Validation of a Pediatric MRI-Based Perianal Crohn Disease (PEMPAC) Index-A Report from the ImageKids
Sapir Choshen1, Dan Turner2,3, Li-Tal Pratt4,5
1Pediatric Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
A new pediatric MRI-based index (PEMPAC) effectively quantifies perianal Crohn disease severity in children. The adult Van Assche index also shows reliability for pediatric use.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Inflammatory Bowel Disease
Background:
- Perianal Crohn disease (CD) significantly impacts children's quality of life.
- Accurate assessment of pediatric perianal CD is crucial for effective management.
- Existing assessment tools may not be fully optimized for pediatric populations.
Purpose of the Study:
- To develop and validate the pediatric MRI-based perianal Crohn disease (PEMPAC) index.
- To establish a reliable tool for quantifying perianal CD severity in children using MRI.
- To compare the PEMPAC index with existing adult indices in a pediatric cohort.
Main Methods:
- Prospective, multicenter ImageKids study involving children with perianal CD findings.
- Pelvic MRI scans analyzed by site and central radiologists.
- Development of statistical models based on radiologist global assessment (RGA) and specific MRI features.
Main Results:
- The PEMPAC index, in both full and basic models, strongly correlated with RGA (r=0.75) and the adult Van Assche index (VAI; r=0.93).
- Both PEMPAC models and the VAI demonstrated similar high accuracy in differentiating disease remission from active disease (AUC 0.91-0.94).
- The PEMPAC index showed good responsiveness to changes in disease activity (AUC 0.89).
Conclusions:
- The developed PEMPAC index provides a validated method for assessing pediatric perianal Crohn disease severity via MRI.
- The adult Van Assche index can also be confidently applied to pediatric patients.
- These tools aid in objective disease evaluation and treatment monitoring in pediatric CD.
Background:
As part of the prospective multicenter ImageKids study, we aimed to develop and validate the pediatric MRI-based perianal Crohn disease (PEMPAC) index.
Methods:
Children with Crohn disease with any clinical perianal findings underwent pelvic magnetic resonance imaging at 21 sites globally. The site radiologist and 2 central radiologists provided a radiologist global assessment (RGA) on a 100 mm visual analog scale and scored the items selected by a Delphi group of 35 international radiologists and a review of the literature. Two weighted multivariable statistical models were constructed against the RGA.
Results:
Eighty children underwent 95 pelvic magnetic resonance imaging scans; 64 were used for derivation and 31 for validation. The following items were included: fistula number, location, length and T2 hyperintensity; abscesses; rectal wall involvement; and fistula branching. The last 2 items had negative beta scores and thus were excluded in a contending basic model. In the validation cohort, the full and the basic models had the same strong correlation with the RGA (r = 0.75; P < 0.01) and with the adult Van Assche index (VAI; r = 0.93 and 0.92; P < 0.001). The correlation of the VAI with the RGA was similar (r = 0.77; P < 0.01). The 2 models and the VAI had a similar ability to differentiate remission from active disease (area under the receiver operating characteristic curve, 0.91-0.94). The PEMPAC index had good responsiveness to change (area under the receiver operating characteristic curve, 0.89; 95% confidence interval, 0.69-1.00).
Conclusions:
Using a blended judgmental and mathematical approach, we developed and validated an index for quantifying the severity of perianal disease in children with CD. The adult VAI may also be used with confidence in children.
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