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Quantitative assessment of terminal ileum motility on MR enterography in Crohn disease: a feasibility study in children

  • Paediatric
  • Published:
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Abstract

Objectives

Investigate the relationship between quantified terminal ileal (TI) motility and histopathological activity grading, Crohn Disease MRI Index (CDMI) and faecal calprotectin.

Methods

Retrospective review of children with Crohn disease or unclassified inflammatory bowel disease, who underwent MR enterography. Dynamic imaging for 25 patients (median age 12, range 5 to 16) was analysed with a validated motility algorithm. The TI motility score was derived. The primary reference standard was TI Endoscopic biopsy Assessment of Inflammatory Activity (eAIS) within 40 days of the MR enterography. Secondary reference standards: (1) the Crohn Disease MRI Index (CDMI) and (2) faecal calprotectin levels.

Results

MR enterography median motility score was 0.17 a.u. (IQR 0.12 to 0.25; range 0.05 to 0.55), and median CDMI was 3 (IQR 0 to 5.5). Forty-three percent of patients had active disease (eAIS > 0) with a median eAIS score of 0 (IQR 0 to 2; range 0 to 5). The correlation between eAIS and motility was r = − 0.58 (p = 0.004, N = 23). Between CDMI and motility, r = − 0.42 (p = 0.037, N = 25). Motility score was lower in active disease (median 0.12 vs 0.21, p = 0.020) while CDMI was higher (median 5 vs 1, p = 0.04). In a subset of 12 patients with faecal calprotectin within 3 months of MR enterography, correlation with motility was r = − 0.27 (p = 0.4).

Conclusions

Quantified terminal ileum motility decreases with increasing histopathological abnormality in children with Crohn disease, reproducing findings in adults. TI motility showed a negative correlation with an MRI activity score but not with faecal calprotectin levels.

Key Points

• It is feasible to perform MRI quantified bowel motility assessment in children using free-breathing techniques.

• Bowel motility in children with Crohn disease decreases as the extent of intestinal inflammation increases.

• Quantified intestinal motility may be a candidate biomarker for treatment efficacy in children with Crohn disease.

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Abbreviations

a.u.:

Arbitrary units

CDMI:

Crohn Disease MRI Index

CRP:

C-reactive protein

DRAM:

Dual Registration of Abdominal Motion

eAIS:

Endoscopic Acute Inflammatory Score

IBD:

Inflammatory bowel disease

IQR:

Interquartile range

MEGS:

Magnetic Resonance Enterography Global Score

PACS:

Picture Archiving and Communication System

SD:

Standard deviation

SSFSE:

Steady-state fast spin echo

TI:

Terminal ileum

TNF:

Tumour necrosis factor

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Acknowledgements

Motilent provided the GIQuant software free of charge for purposes of this study. The Centre for Medical Imaging, University College London, provided statistical support via HF and AM. This research project was supported by researchers (SAT) at the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

Funding

The authors state that this work has not received any direct funding. SAT receives funding from the National Institute for Health Research University College London Hospitals Biomedical Research Centre. HF is funded by the Biotechnology and Biological Sciences Research Council (BBSRC) London Interdisciplinary Doctoral (LIDo) Consortium [BB/M009513/1] and receives funding from Motilent as part of an industrial placement.

Author information

Authors and Affiliations

  1. Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, UK

    Lucia Cococcioni & Fevronia Kiparissi

  2. Centre for Medical Imaging, University College London, London, UK

    Heather Fitzke, Alex Menys, Shankar Kumar & Stuart A. Taylor

  3. Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK

    Heather Fitzke

  4. Department of Paediatric Radiology, University College Hospital London, London, UK

    Trevor Gaunt

  5. Department of Pathology, Great Ormond Street Hospital for Children, London, UK

    Dyanne Rampling & Liina Palm

  6. Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, Wc1N 3JH, UK

    Tom A. Watson

Authors
  1. Lucia Cococcioni
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Contributions

LC: collected and analysed clinical and histopathology data, and reviewed and edited the final manuscript

HF: provided statistical analysis and created all graphs and statistical diagrams, and reviewed and edited the final manuscript

AM: image analysis with TW and statistical analysis; reviewed and edited the early and final versions of the manuscript

TG: image analysis and reviewed and edited the final copy of the manuscript

SK: radiological data collection and analysis; reviewed and edited the final version of the manuscript

FK: clinical data collection; reviewed and edited the final version of the manuscript

DR and LP: histopathology data analysis; reviewed and edited the final version of the manuscript

SAT: supervised data analysis; reviewed and edited all versions of the manuscript including the final version

TW: corresponding author. TW supervised data collection, analysed the motility data, performed the MRI activity scoring, and prepared the final manuscript for publication

Corresponding author

Correspondence to Tom A. Watson.

Ethics declarations

Guarantor

The scientific guarantor of this publication is:

Professor Stuart Taylor, NIHR Senior Investigator and Consultant Radiologist, University College London, Centre for Medical Imaging.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

AM—CEO, Motilent

SAT—Motilent shareholder and paid consultant for Robarts

HF—funded for her PhD and for her industrial placement at Motilent by the Biotechnology and Biological Sciences Research Council (BBSRC) London Interdisciplinary Doctoral (LIDo) Consortium [BB/M009513/1]. She has received funding from Motilent to cover travel expenses to conferences as part of her industrial placement. She has had free use of Motilent GIQuant during her PhD.

The remaining authors declare no relevant conflicts of interest.

Statistics and biometry

Two of the authors have significant statistical expertise (HF and AM).

Informed consent

Written informed consent was waived by the Institutional Review Board. R&D Reference number 18BB10.

Ethical approval

Institutional Review Board approval was obtained. REC number 10/H0720/91GOSH.

Methodology

• retrospective

• cross-sectional study

• performed at one institution

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Cococcioni, L., Fitzke, H., Menys, A. et al. Quantitative assessment of terminal ileum motility on MR enterography in Crohn disease: a feasibility study in children. Eur Radiol 31, 775–784 (2021). https://doi.org/10.1007/s00330-020-07084-1

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  • DOI: https://doi.org/10.1007/s00330-020-07084-1

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