Advances in Clinical and Experimental Medicine
2016, vol. 25, nr 1, January-February, p. 111–115
Publication type: original article
Assessment of Magnetic Resonance Enterography in the Diagnosis of Small Bowel Diseases in Children with Crohn’s Disease
1 Department of Pediatrics, Gastroenterology and Nutrtion, Wroclaw Medical University, Poland
2 Diagnostic Imaging Laboratory, Copper Health Center, Lubin, Poland
Background. In pediatric patients Crohn’s disease most commonly involves the colon and the ileocecal part of the intestine. MR enterography, a new method of small bowel imaging with magnetic resonance, has been introduced in the last decade.
Objectives. The aim of this study was to assess the usefulness of the MR enterography in the diagnosis of small bowel lesions in children with Crohn’s disease.
Material and Methods. The study included 37 children (18 girls and 19 boys) aged from 5.5 to 18 years (average age, 13.3), diagnosed with Crohn’s disease according to the Porto criteria. The disease duration ranged from 1 month to 12 years, on average 3 years. MR eterography was performed according to the Giles et al. protocol. The obtained results were compared with the location and the manifestation of the disease according to the Paris classification.
Results. In 13 children (35.1%), the disease began prior to 10 years of age, and in the remaining 24 children (64.9%) between 10 and 17 years of age. The gastrointestinal endoscopy confirmed Crohn’s disease in the colon (45.9%) and in the colon and ileum (27.1%). An incomplete colonoscopy examination which did not reveal the location of the disease was conducted in 7 children (18.9%). A comparison of the location of Crohn’s disease with the location of lesions in the small bowel as indicated by MR enterography revealed that the most common changes can be found in the final part of ileum, in ileum, and in 4 children in jejunum. MR enterography demonstrated, that 16 children (43.2%) had inflammation, 7 children (18.9%) stenosis, and 14 children (37.8%) had no lesions at all.
Conclusion. MR enterography is a non-invasive and safe procedure well tolerated by children that allows the visualization of lesions in the small bowel in children with Crohn’s disease.
children, Crohn’s disease, MR enterography
- Van Assche G, Dignass A, Reinisch W: The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Special situations. J Crohns Colitis 2012, 4, 63–101.
- Levine A, Griffiths A, Markowitz J, Wilson DC, Turner D, Russel RK, Fell J, Ruermmele FM, Walters T, Sherlok M, Dubinsky M, Hyams J: Pediatric Modification of the Montreal Classification for Inflammatory Bowel Disease: The Paris Classification. Inflamm Bowel Dis 2011, 17, 1314–1321.
- Amitai MM, Ben-Horin S, Eliakim R, Kopylov U: Magnetic resonanse enterography in Crohn’s disease: A guide to common imaging manifestations for the IBD physician, J Crohns Colitis 2013, 7, 603–615.
- Sanka S, Gomez A, Set P, Rimareva N, Davies RJ, Rolfe P, Noble-Jamieson G, Torvente F, Heuschkel R, Zilbauer M: Use of small bowel MRI enteroclysis in the management of paediatric IBD. J Crohns Colitis 2012, 6, 550–556.
- MGee MS, Nimkin K, Hsu M, Israel EJ, Biller JA, Katz AJ, Mino-Kenudson M, Harisinghani MG: Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn’s disease assessment. AJR Am Roentgenol 2011, 197, 224–231.
- Martin DR, Lauenstein T, Sitaraman SV: Utility of Magnetic Resonance Imaging in Small Bowel Crohn’s Disease. Gastroenterology 2007, 133, 385–390.
- Markova I, Kluchova K, Zboril R, Mashlan M, Herman M: Small bowel imaging – still a radiologic approach? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2010, 154, 123–132.
- Giles E, Hanci O, McLean A, Power N, Cole A, Craft NM, McDonald K, Chippington S, Naik S: Optimal Assessment of Paediatric IBD With MRI and Barium Follow-through. J Pediatr Gastroenterol Nutr 2012, 54, 6, 758–762.
- Chatu S, Subramanian V, Pollok RCG: Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther 2012, 35, 529–539.
- Giles E, Barclay AR,Chippington S, Wilson DC: Systematic review: MRI enterography for assessment of small bowel involvement in paediatric Crohn’s disease. Aliment Pharmacol Ther 2013, 37, 1121–1131.
- IBD Working Group of the European Society for Pediatric Gastroenterology Hepatology and Nutrition. Inflammatory bowel disease in children and adolescents: recommendation for diagnosis – the Porto criteria. J Pediatr Gastroenterol Nutr 2005, 41, 1–7.
- Silverstein J, Grand D, Kawatu D, Shah SA, Steinkeler J, LeLeiko N: Feasibility of using MR enterography for the assessment of terminal ileitis and inflammatory activity in children with Crohn disease. J Pediatr Gastroenterol Nutr 2012, 55, 173–177.
- Sauer CG, Middleton JP, Alazraki A, Udayasankar UK, Kalb B, Applegate KE, Martin DR, Kugathasan S: Comparison of magnetic resonance enterography with endoscopy, histopathology, and laboratory evaluation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2012, 55, 178–184.
- Courtier J, Ohliger M, Rhee SJ, Terreblanche O, Heyman MB, MacKenzie JD: Shooting a moving target: use of real-time cine magnetic resonance imaging in assessment of the small bowel. J Pediatr Gastroenterol Nutr 2013, 57, 426–431.