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Prognostic value of magnetic resonance enterography for children with Crohn's disease: A multicenter, multireader
Anastasiia Romanchuk1, Clarissa Valle2, Arianna Ghirardi3
1Department of Pediatrics, Pediatric Infectious Diseases, Immunology and Allergology, Shupyk National Healthcare University of Ukraine, Ukraine; Pediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
Insights
The Paediatric Inflammatory Crohn's MRE Index (PICMI) reliably assesses pediatric Crohn's disease activity. Higher PICMI scores at diagnosis predict a greater need for biologic therapies to achieve remission.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Inflammatory Bowel Disease
Background:
- The Paediatric Inflammatory Crohn's MRE Index (PICMI) evaluates intestinal inflammation in pediatric Crohn's disease (CD).
- Assessing PICMI's predictive value for disease course and its inter-reader reliability is crucial.
Purpose of the Study:
- To determine if the PICMI score at diagnosis can predict the long-term course of pediatric Crohn's disease.
- To evaluate the inter-reader agreement of the PICMI score.
Main Methods:
- Retrospective enrollment of pediatric CD patients with at least a one-year follow-up.
- Radiologists calculated PICMI scores at diagnosis.
- Correlations between PICMI, Paediatric Crohn's Disease Activity Index (PCDAI), and CD Endoscopic Index of Severity (CDEIS) were analyzed.
Main Results:
- 68 children with CD were analyzed; PICMI scores correlated significantly with PCDAI at diagnosis.
- Higher initial PICMI scores were associated with increased need for biologic therapy introduction at 1, 3, and 5 years.
- Steroid-free remission rates were comparable across different PICMI severity groups.
Conclusions:
- The PICMI score is a reliable and reproducible tool for assessing disease activity in pediatric Crohn's disease.
- Children with higher PICMI scores at diagnosis require more intensive treatment, including biologics, to achieve similar remission rates.
Background:
Paediatric Inflammatory Crohn's MRE Index (PICMI) is a multi-point index of intestinal inflammation (mucosal and transmural) for children with CD. The present study aims to assess whether PICMI at diagnosis may predict the course of CD and to test the inter-reader agreement.
Methods:
CD children with a ≥ 1-year follow-up were retrospectively enrolled. Three radiologists calculated PICMI at diagnosis and association between PICMI and Paediatric Crohn's Disease Activity Index (PCDAI) and CD Endoscopic Index of Severity (CDEIS) was tested.
Results:
68 children (median age 13 years IQR: 11-14) with CD with PICMI at diagnosis: remission 6 (8.8 %), mild 29 (42.6 %), moderate 24 (35.3 %), severe 9 (13.2 %), were enrolled. PICMI score significantly correlated with PCDAI at diagnosis (p: 0.036). Steroid-free remission at 1, 3 and 5 years was comparable between PICMI groups (p: 0.606). Higher PICMI at diagnosis was associated with higher biologic introduction at 1 year: incidence rate ratio IRR: 2.17 (1.09-4.42); p = 0.019, 3-year IRR: 2.12 (1.15-3.96); p = 0.011, and 5 years: 2.21 (1.20-4.08); p = 0.007.
Conclusions:
PICMI score is a reliable and almost reproducible index to score activity in children with CD. Children with higher PICMI scores of disease activity at diagnosis required more biologic treatment to achieve comparable rates of steroid-free remission if compared with lower PICMI scores.
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