Quantified small bowel motility assessment on magnetic resonance enterography in paediatric inflammatory bowel
Riwa Meshaka1, Heather E Fitzke2, Joy Barber3
1Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK. riwa.meshaka@gosh.nhs.uk.
Insights
Quantified small bowel motility using cine magnetic resonance enterography (MRE) reflects treatment response in pediatric inflammatory bowel disease. This motility index is more sensitive than the sMaRIA score for detecting treatment response.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Inflammatory Bowel Disease Research
Background:
- Cine magnetic resonance enterography (MRE) offers quantified small bowel motility assessment, showing promise as a biomarker in adult inflammatory bowel disease.
- The correlation between quantified motility and treatment response in pediatric inflammatory bowel disease remains unestablished.
Purpose of the Study:
- To evaluate if changes in quantified small bowel motility correlate with treatment response in pediatric inflammatory bowel disease patients.
Main Methods:
- A retrospective study included children under 18 with confirmed inflammatory bowel disease and multiple MREs between 2011-2022.
- Two experienced radiologists assessed the simplified MaRIA (sMaRIA) score and motility index (quantified motility) in terminal ileum and diseased non-terminal ileum segments.
- Changes in motility index (Δ motility index) were compared to clinical global assessment and a consensus radiological reference standard (≥2-point decrease in sMaRIA) using the Mann-Whitney test.
Main Results:
- Out of 64 pediatric patients, 33% were responders, 58% non-responders, and 9% had inactive disease.
- Both radiologists found a significantly higher Δ motility index in responders (+16, +39) compared to non-responders (-43, -44) (P=0.04, P=0.01).
- The motility index demonstrated higher sensitivity (57% vs. 24%) but lower specificity (67% vs. 93%) than sMaRIA in identifying clinical response.
Conclusions:
- The motility index derived from cine MRE correlates with clinical treatment response in pediatric inflammatory bowel disease.
- Quantified motility assessment via MRE is more sensitive than the sMaRIA score for detecting treatment response in this population.
Background:
Quantified small bowel motility assessment using cine magnetic resonance enterography (MRE) has shown promise as a biomarker in adult inflammatory bowel disease. Whether quantified motility corresponds to treatment response in paediatric inflammatory bowel disease is unknown.
Objective:
To test whether changes in motility reflect response.
Materials And Methods:
Local ethics approval was granted for this single-institution, retrospective study. All children < 18 years with confirmed inflammatory bowel disease, who had more than one MRE between Jan 2011-Jan 2022, were included. Simplified MaRIA (sMaRIA) and motility index (quantified motility) at all terminal ileum and diseased non-terminal ileum segments were independently assessed by two radiologists each with ≥ 9 years' experience. Change in (Δ) motility index was compared to clinical (gastroenterologist physician's global assessment) and consensus radiological reference standard (response = decrease in sMaRIA of more than or equal to 2 points) in responders versus non-responders using the Mann-Whitney test. Sensitivity and specificity of Δ motility index more than zero were compared to decrease in sMaRIA of 2 or more points for identifying clinical response.
Results:
Of 64 children aged 5-16, 21 out of 64 (33%) were responders, 37 out of 64 (58%) were non-responders and 6 out of 64 (9%) had inactive disease according to clinical reference standard. Δ Motility index by both radiologists was higher in responders (+ 16, + 39) than non-responders (-43, -44), P = 0.04, P = 0.01 each radiologist, respectively. Motility index was more sensitive (57% versus 24%), but less specific (67% versus 93%) than sMaRIA in identifying clinical response.
Conclusion:
Motility index on cine MRE corresponds to clinical response, and is more sensitive at detecting response compared to sMaRIA in paediatric inflammatory bowel disease.
Related Concept Videos
01:26Imaging Studies III: Gastrointestinal Motility Studies and Virtual Colonoscopy
Radionuclide Testing
Radionuclide testing is a sophisticated medical technique for assessing gastrointestinal motility. It focuses on gastric emptying and colonic transit time. Radioactive markers track the movement of food through the digestive system, providing insights into gastrointestinal disorders.
In gastric emptying studies, a meal's liquid and...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:20Gastrointestinal Motility Disorders
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are:
01:25Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...