Sensitivity Of Magnetic Resonance Enterography Research Articles

Pediatrik İnflamatuar Bağırsak Hastalıklarının Tanısında ve Ayrımında Manyetik Rezonans Enterografinin Rolü

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.

Correlation between magnetic resonance enterography and ileo-colonoscopy for assessment of disease activity in terminal ileal Crohn's disease.

Magnetic resonance enterography (MRE) has emerged as a novel tool for the assessment of disease activity in Crohn's disease (CD). Real world data from Indian subcontinent on performance of MRE in terminal ileal CD are lacking. Retrospective analysis of patients with terminal ileal CD who underwent both ileo-colonoscopy and MRE was performed. Ileo-colonoscopy was considered the gold standard for assessment of disease activity. On ileo-colonoscopy, a simple endoscopic score for Crohn's disease (SES-CD) ≥2 was considered active disease; presence of ulcers indicated severe disease. MRE scoring of the disease activity was performed using magnetic resonance index of activity (MARIA) and simplified MARIA (MARIAs). The measure of agreement between ileo-colonoscopy and MRE and comparison of MARIA and MARIAs for assessment of disease activity and sensitivity of MRE to detect mucosal ulcerations were calculated. Seventy patients with terminal ileal CD (mean age 40.74±15.56 years; 71.4% males [n=50]) were evaluated. The sensitivities of MARIA and MARIAs scores to detect active disease were 0.76 and 0.84, respectively. The area under the receiver operating characteristic curve (AUROC) for detecting severe disease was 0.836 (p<0.0001) for MARIA and 0.861 (p<0.0001) for MARIAs. For mild active disease, there was no agreement between SES-CD and MARIA or MARIAs; however, for severe disease, the agreement was fair and moderate for MARIA and MARIAs, respectively. MARIA and MARIAs were comparable for identification of active and severe disease (κ 0.759, p<0.0001 and κ 0.840, p<0.0001, respectively). MRE was 68.18% sensitive to detect mucosal ulcers. MRE is a reliable and sensitive tool for detection of endoscopically severe, but not mild, terminal ileal CD.

Usefulness of Colon Assessment by Magnetic Resonance Enterography in Pediatric Patients with Inflammatory Bowel Disease-Retrospective Case Series.

Background: Magnetic resonance enterography (MRE) is an excellent way to study the small bowels. During such an examination, the colon is also seen within the field of study. The aim of this study was to evaluate the effectiveness of MRE in detecting characteristics of active inflammatory bowel disease (IBD) in the colon, in comparison to different features seen in colonoscopies. Methods: This retrospective study was conducted with 41 children. Features of active inflammation we considered were wall thickening; contrast enhancement; incorrect signal in the DWI sequence in the MRE; and presence of ulceration, erosion, erythema, spontaneous bleeding and a decrease of the vascular pattern seen in colonoscopy. The colon was divided into six segments: caecum, ascending, transverse, descending, sigmoid and rectum. Results: The sensitivity of MRE was, on average, 50–75%, and as high as 92–100%, depending on the segment. The most important feature for which there was the most dependencies was ulceration. In the analysis of intestinal wall thickness, the AUC value >0.8 was detected as ulceration (segments: cecum, ascending, descending colon, sigmoid), spontaneous bleeding (ascending colon and sigmoid) and decreased vascular pattern (ascending, transverse, descending colon). Conclusions: Evaluation of qualitative structural changes in MRE distinguishes patients with inflammation in colonoscopy from patients without lesions, with high diagnostic accuracy, albeit higher specificity than sensitivity.

Diagnostic accuracy of intestinal ultrasound and magnetic resonance enterography for the detection of endoscopy-based disease activity in ileocolonic Crohn's disease.

Crohn's disease (CD) is characterised by chronic gastrointestinal inflammation with relapsing-remitting behaviour and often requires endoscopic and/or radiologic assessment. The objective of this study was to compare the diagnostic accuracy of intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) for the assessment of disease activity in CD using a simple endoscopic score for CD as a reference standard. A prospective observational study was carried out in 71 consecutive adult patients with known CD, attending our tertiary inflammatory bowel disease clinic, between November 2014 and July 2016. Ileocolonoscopy, IUS and MRE were performed within 1 month prospectively. The simple endoscopic score-CD 0-2 was accepted as remission. The sensitivity of IUS and MRE for detecting endoscopic activity was found similar with regard to bowel wall thickening and mesenteric fibrofatty proliferation (P>0.05). The overall accuracy for detecting mural lesions was similar between IUS and MRE. When mural lesions were analysed, the sensitivity of MRE in detecting the loss of wall stratification and stenosis was significantly higher than IUS (P<0.001 for both). IUS showed higher specificity for bowel wall thickening, loss of wall stratification and stenosis (P=0.009, P<0.001 and P<0.001, respectively). Sensitivity and accuracy of IUS were higher in detecting ascites in active disease (P=0.002). Our results showed that IUS and MRE were equally accurate in detecting endoscopic activity. IUS may be the preferred technique for the evaluation of disease activity and for the follow-up of CD.

P318 Accuracy of magnetic resonance enterography for extraluminal complications of Crohn's disease

Background: Crohn's disease (CD) can be associated with intraluminal and extraluminal complications like abscess and fistula. More than half of patients with Crohn's disease need surgery to treat these complications at least once in their life. Aiming to make an appropriate choice of intervention, the magnetic resonance enterography (MRE) is largely used to assess the type and severity of these complications. In a previous prospective study pre-operative MRE has been able to predict surgical approach in the most of symptomatic patients, showing low sensitivity and high specificity for the diagnosis of fistula or abscess and high sensitivity and low specificity for stenosis. Methods: We reviewed a sample from a referral center of 42 consecutive symptomatic CD patients addressed to surgery who underwent preoperative MRE. All data were recorded in an electronic database (Excel Microsoft). We analyzed the concordance between MRI and surgical findings for presence of fistulas or abscesses and other stenosis-related characteristics (location, number and extent). We calculated the proportions of VP, FN, FP and VN with 95% confidence limits and the accuracy of the index test (MRE) compared to the reference test (surgery) for the diagnosis of stenosis, fistula or abscess. Results: Fifty-two percent of patients were male, mean age was 40.5±13.6 years. Forthy-one (98%) were symptomatic. The median time between MRE performance and surgery was 2 months (range 1–24); time was 3 months in 29 pts (69%). A laparoscopic approach was performed in 69% of patients. The prevalence of fistula at surgery was 24% and of abscess 17%. MRE failed in detecting fistulas in 2 patients and falsely identified abscess in one patient. Sensitivity and specificity of MRE were 40% and 99% for fistula and 67% and 94% for abscess, respectively. Accuracy of MRE for fistula was 76% (95% CI 60–88%) and for abscess 88% (95% CI 69–93). For detection of single and multiple stenosis the sensitivity of MRE was 93% and 88% respectively. Conclusions: The MRE was a fairly accurate imaging test for the characterization of stenosis and for the diagnosis of fistula or abscess. Taking into account limitations due to retrospective data, MRE shows high specificity and low sensitivity for the diagnosis of fistula and abscess according to data from literature. Moreover, it appears more useful to identify the site and extension of stenosis and the single stenosis with respect to the multiple. Aiming to optimize the decision about surgery, there is still a need for development of shared criteria among radiologists and surgeons to further assess the reproducibility of MRE and its accuracy for the diagnosis of complications in prospective studies of patients with CD

PWE-004 Diagnostic Accuracy of Magnetic Resonance Enterography in Detecting Small Bowel Crohn’s Disease – Relationships with Faecal Calprotectin

Introduction Around one third of patients with Crohn’s disease (CD) have isolated small bowel involvement at diagnosis. Magnetic resonance enterography (MRE) is a recognised tool for identifying small bowel disease. Faecal calprotectin (FCp) is a marker to help differentiate functional from organic gastrointestinal symptoms and is typically elevated in CD. This study aims to determine the diagnostic accuracy of MRE in patients with symptoms suspicious for CD and assess the relationship between FCp and presence of small bowel disease on MRE. Methods Patients with suspicion for CD who underwent MRE over a 23 month period (Jan 2013 to Nov 2014) were identified using a local database. All study patients had undergone a normal colonoscopy to exclude Crohn’s colitis. MRE reports were reviewed for evidence of small bowel abnormalities, and whether these were likely to represent CD. FCp levels (μg/g) from 3 months preceding MRE were recorded. Casenote review revealed outcome and patient disposition at 1 year post-MRE. Results In total 73 patients underwent MRE (mean age 37.5; range 13–77; 46:27 female:male). 3 had MRE findings radiologically diagnostic for CD, their FCp ranged from 389 to 600. 19/73 patients had MRE features of non specific ileitis with corresponding median FCp level of 222 (inter-quartile range [IQR] 71–600). At 1 year a further of 3 of these 19 patients (FCp range 294–600) were positively diagnosed as CD. Of the remaining 16 with non specific ileitis on MRE, none had CD at 1 year. In this sub-group the median FCp was 139 (45–517), 5 had a normal capsule endoscopy, 12 had functional pain, 3 had infectious ileitis, and 1 was lost to follow-up. The majority of patients however (51/73 [69.9%]) had normal MRE with a median FCp of 142 (83–416) and none had CD at 1 year. Median differences in the FCp value between those with normal and abnormal MRE were apparent but not statistically significant (p = 0.42). Overall sensitivity of MRE in diagnosing small bowel involvement is high at 100% as is a negative predictive value of 100% although we acknowledge the small sample size. Within the group reported as indeterminate Ileitis only 3/19 were subsequently diagnosed with Crohn’s disease. Conclusion MRE excels in excluding small bowel CD in suspected patients and is reliable when positively diagnosing Crohn’s. In early Crohn’s disease there is uncertainty in differentiating the radiological appearances with other causes of ileitis. These data support the development of an appropriate threshold for abnormal FCp as a screening tool to improve MRE accuracy. This could reduce the number of unnecessary MRE examinations without missing any cases of small bowel CD. Disclosure of Interest None Declared

Inflammatory Bowel Disease in Children and Adolescents: Assessing the Diagnostic Performance and Interreader Agreement of Magnetic Resonance Enterography Compared to Histopathology

The purpose of this study was to determine the accuracy of magnetic resonance enterography (MRE) compared to histopathology in the evaluation of pediatric inflammatory bowel disease and to assess interreader reliability for image interpretation.All magnetic resonance enterography studies performed for known or suspected inflammatory bowel disease between July 2009 and July 2010 were retrospectively reviewed by two pediatric radiologists. Exams were evaluated for signs of enteric inflammation and extraenteric disease. A five-point, Likert-type scale was used to assess the overall likelihood of active inflammation, with scores ≥ 3 considered positive. Cohen's κ coefficient was calculated to assess interreader agreement. A subset of patients who had undergone ileocolonoscopy or surgery with confirmed histopathology within 45 days of MRE were used to assess the accuracy of MRE for detecting active inflammation in the terminal ileum and large bowel.A total of 91 magnetic resonance enterography studies were reviewed. Of these, 45 had comparison histopathology within 45 days. The overall sensitivity of MRE for detecting active inflammation compared to ileocolonoscopy was 92% for both readers, while specificity was 100% for reader 1 and 75% for reader 2. Of the individual parameters evaluated, mucosal hyperenhancement and bowel wall thickening were the most sensitive indicators of active inflammation, each having sensitivity of 86% and specificity of 88%. Cohen's κ coefficient was 0.59, indicating moderate agreement between the readers.MRE has high overall diagnostic accuracy for detecting active bowel inflammation in pediatric patients compared to ileocolonoscopy and demonstrates moderate interreader reliability.

Usefulness of Magnetic Resonance Enterography in Diagnosis of Crohn's Disease

The numbers of patients with diagnosed Crohn's disease in Poland continue to be on the rise. It may be assumed that it is associated not with an increased incidence but with significant advancements in diagnostic techniques which in an increasingly better manner solve problems of abdominal pain. One of such methods is magnetic resonance enterography, which gives high hope in the diagnostics of Crohn's disease. The aim of the study was the evaluation of the results of magnetic resonance enterography (MREG) and their comparison with the results of histopathological examination o perioperative specimens. The clinical material comprised 48 patients with suspected Crohn's disease. Colonoscopy was performed in all the patients, followed by magnetic resonance enterography, which evaluated the lesion localisation, large intestine wall thickening, small intestine stenosis, mesenteric vessel proliferation, infiltration of surrounding adipose tissue, lymph node enlargement, presence of enteroenteral, enterovesical and enterocutaneous fistulas. Next, a surgical procedure was performed, with collection of specimen for histopathology. The examination results were compared with those of magnetic resonance enterography. MREG was performed in 48 individuals. Suspected Crohn's disease based on the above examination was diagnosed in 35 cases, isolated small intestine inflammation--in 5, and fibrosis in the remaining 5 patients. No significant differences were found between the lesion localisation done by MREG or perioperativelly. Crohn's disease was confirmed by histopathology in 36 cases. The sensitivity of MREG with histopathology was 91.6%, and the specificity--77.8%. Magnetic resonance enterography is a highly effective and sensitice method in the diagnostics of Crohn's disease, free of adverse effects and possible to be performed even in pregnant female patients.