The Role of Magnetic Resonance Enterography for Detection and Differentiation of Pediatric Inflammatory Bowel Diseases
Abstract
Background/Aims: Inflammatory bowel diseases (IBD) are of two types: Crohn’s disease (CD) and ulcerative colitis (UC). The differential diagnosis of these two diseases is important because their treatment strategies are different. The present study aimed to evaluate the Magnetic Resonance Enterography (MRE) findings of pediatric patients who were clinically diagnosed with CD or UC.
Material and Method: The patients under the age of 18, who underwent MRE examination, were retrospectively screened. Fifty five of those patients, who were clinically diagnosed with CD or UC, were included in the study. Bowel wall thickening, mesenteric fat tissue changes and complications were evaluated, and the findings were recorded. The sensitivity and specificity of MRE in the diagnosis of CD and UC in IBD patients were calculated.
Results: Three of the patients clinically diagnosed with CD (7.3%) and six patients who had UC (42.9%) had involvement from the rectum to the proximal colonic segments (continuous lesions). Of those diagnosed with CD, 11 (26.8%) had skip lesions. In patients with IBD, the sensitivity of MRE for the diagnosis of CD was 56.1% and the specifity was 100%. The sensitivity of MRE for the diagnosis of UC was 42.9% and the specificity was 90.2%.
Conclusion: MRE is helpful to identify the signs and complications of inflammatory bowel diseases. Although MRE has low sensitivity to differentiate between CD or UC in pediatric patients, it may help with its high specificity rates.
Keywords
Crohn, Inflammatory Bowel Diseases, Magnetic Resonance Enterography, Ulcerative Colitis
References
- Ziech ML, Hummel TZ, Smets AM, Nievelstein RA, Lavini C, Caan MW, et al. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatr Radiol 2014;44:1370-1378.
- Oliveira SB, Monteiro IM. Diagnosis and management of inflammatory bowel disease in children. BMJ 2017;357:j2083.
- Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis 2008;14 Suppl 2:S9-11.
- Kaushal P, Somwaru AS, Charabaty A, Levy AD. MR Enterography of Inflammatory Bowel Disease with Endoscopic Correlation. Radiographics 2017;37:116-131.
- Sinha R, Verma R, Verma S, Rajesh A. MR enterography of Crohn disease: part 2, imaging and pathologic findings. AJR Am J Roentgenol 2011;197:80-85.
- Chalian M, Ozturk A, Oliva-Hemker M, Pryde S, Huisman TA. MR enterography findings of inflammatory bowel disease in pediatric patients. AJR Am J Roentgenol 2011;196:W810-816.
- Fernandes, T., Oliveira, M.I., Castro, R, Araújo B, Viamonte B, Cunha R. Bowel wall thickening at CT: simplifying the diagnosis. Insights Imaging 2014;5:195–208.
- Gale HI, Sharatz SM, Taphey M, Bradley WF, Nimkin K, Gee MS. Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol 2017;47:1321-1328.
- Yu YR, Rodriguez JR. Clinical presentation of Crohn's, ulcerative colitis, and indeterminate colitis: Symptoms, extraintestinal manifestations, and disease phenotypes. Semin Pediatr Surg 2017;26:349-355.
- Heyman MB, Kirschner BS, Gold BD, Ferry G, Baldassano R, Cohen SA et al. Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr 2005;146:35-40.