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Pediatric Radiology
Published in: Pediatric Radiology 10/2017

01-09-2017 | Original Article

Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents

Authors: Heather I. Gale, Steven M. Sharatz, Mayureewan Taphey, William F. Bradley, Katherine Nimkin, Michael S. Gee

Published in: Pediatric Radiology | Issue 10/2017

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Abstract

Background

Assessment for active Crohn disease by CT enterography and MR enterography relies on identifying mural and perienteric imaging features.

Objective

To evaluate the performance of established imaging features of active Crohn disease in children and adolescents on CT and MR enterography compared with histological reference.

Materials and methods

We included patients ages 18 years and younger who underwent either CT or MR enterography from 2007 to 2014 and had endoscopic biopsy within 28 days of imaging. Two pediatric radiologists blinded to the histological results reviewed imaging studies and scored the bowel for the presence or absence of mural features (wall thickening >3 mm, mural hyperenhancement) and perienteric features (mesenteric hypervascularity, edema, fibrofatty proliferation and lymphadenopathy) of active disease. We performed univariate analysis and multivariate logistic regression to compare imaging features with histological reference.

Results

We evaluated 452 bowel segments (135 from CT enterography, 317 from MR enterography) from 84 patients. Mural imaging features had the highest association with active inflammation both for MR enterography (wall thickening had 80% accuracy, 69% sensitivity and 91% specificity; mural hyperenhancement had 78%, 53% and 96%, respectively) and CT enterography (wall thickening had 84% accuracy, 72% sensitivity and 91% specificity; mural hyperenhancement had 76%, 51% and 91%, respectively), with perienteric imaging features performing significantly worse on MR enterography relative to CT enterography (P < 0.001).

Conclusion

Mural features are predictors of active inflammation for both CT and MR enterography, while perienteric features can be distinguished better on CT enterography compared with MR enterography. This likely reflects the increased conspicuity of the mesentery on CT enterography and suggests that mural features are the most reliable imaging features of active Crohn disease in children and adolescents.
Literature
1.
Floyd DN, Langham S, Séverac HC et al (2015) The economic and quality-of-life burden of Crohn's disease in Europe and the United States, 2000 to 2013: a systematic review. Dig Dis Sci 60:299–312CrossRefPubMed
2.
Benchimol EI, Fortinsky KJ, Gozdyra P et al (2011) Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 17:423–439CrossRefPubMed
3.
Baumgart DC, Carding SR (2007) Inflammatory bowel disease: cause and immunobiology. Lancet 369:1627–1640CrossRefPubMed
4.
Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517CrossRefPubMed
5.
6.
Maglinte DD, Gourtsoyiannis N, Rex D et al (2003) Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin N Am 41:285–303CrossRefPubMed
7.
Clark M, Colombel JF, Feagan BC et al (2007) American Gastroenterological Association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21–23, 2006. Gastroenterography 133:312–339CrossRef
8.
Spinelli A, Correale C, Szabo H et al (2010) Intestinal fibrosis in Crohn's disease: medical treatment or surgery? Curr Drug Targets 11:242–248CrossRefPubMed
9.
Anupindi SA, Grossman AB, Nimkin K et al (2014) Imaging in the evaluation of the young patient with inflammatory bowel disease: what the gastroenterologist needs to know. J Pediatr Gastroenterol Nutr 59:429–439CrossRefPubMed
10.
Martin DR, Lauenstein T, Sitaraman SV (2007) Utility of magnetic resonance imaging in small bowel Crohn's disease. Gastroenterology 133:385–390CrossRefPubMed
11.
Lee SS, Kim AY, Yang SK et al (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251:751–761CrossRefPubMed
12.
Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol 197:224–231CrossRefPubMedPubMedCentral
13.
Quencer KB, Nimkin K, Mino-Kenudson M et al (2013) Detecting active inflammation and fibrosis in pediatric Crohn's disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38:705–713CrossRefPubMedPubMedCentral
14.
Dillman JR, Adler J, Zimmermann EM et al (2010) CT enterography of pediatric Crohn disease. Pediatr Radiol 40:97–105CrossRefPubMed
15.
Oommen J, Oto A (2011) Contrast-enhanced MRI of the small bowel in Crohn’s disease. Abdom Imaging 36:134–141CrossRefPubMed
16.
Anupindi SA, Podberesky DJ, Towbin AJ et al (2015) Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging 40:975–992CrossRefPubMed
17.
Moy MP, Sauk J, Gee MS (2016) The role of MR enterography in assessing Crohn's disease activity and treatment response. Gastroenterol Res Pract 2016:8168695CrossRefPubMed
18.
Smolinski S, George M, Dredar A et al (2014) Magnetic resonance enterography in evaluation and management of children with Crohn's disease. Semin Ultrasound CT MR 35:331–348CrossRefPubMed
19.
Qiu Y, Mao R, Chen BL et al (2014) Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease. Aliment Pharmacol Ther 40:134–146CrossRefPubMed
20.
Mollard BJ, Smith EA, Lai ME et al (2016) MR enterography under the age of 10 years: a single institutional experience. Pediatr Radiol 46:43–49CrossRefPubMed
21.
22.
Siddiki HA, Fidler JL, Fletcher JG et al (2009) Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol 193:113–121CrossRefPubMed
23.
Singh S, Kalra MK, Moore MA et al (2009) Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 252:200–208CrossRefPubMed
24.
25.
Efron B (1979) Bootstrap methods: another look at the jackknife. Ann Stat 7:1–26CrossRef
26.
27.
Huprich JE, Rosen MP, Fidler JL et al (2010) ACR appropriateness criteria on Crohn's disease. J Am Coll Radiol 7:94–102CrossRefPubMed
28.
Hammer MR, Podberesky DJ, Dillman JR (2013) Multidetector computed tomographic and magnetic resonance enterography in children: state of the art. Radiol Clin N Am 51:615–636CrossRefPubMed
29.
Makanyanga JC, Taylor SA (2013) Current and future role of MR enterography in the management of Crohn disease. AJR Am J Roentgenol 201:56–64CrossRefPubMed
30.
Duigenan S, Gee MS (2012) Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol 199:907–915CrossRefPubMed
31.
Towbin AJ, Sullivan J, Denson LA et al (2013) CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics 33:1843–1860CrossRefPubMed
Metadata
Title
Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents
Authors
Heather I. Gale
Steven M. Sharatz
Mayureewan Taphey
William F. Bradley
Katherine Nimkin
Michael S. Gee
Publication date
01-09-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 10/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-017-3876-z

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