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MRI reveals different Crohn’s disease phenotypes in children and adults

  • Francesca MaccioniEmail author
  • Davide Bencardino
  • Valeria Buonocore
  • Fabrizio Mazzamurro
  • Franca Viola
  • Salvatore Oliva
  • Piero Vernia
  • Manuela Merli
  • Anna Rita Vestri
  • Carlo Catalano
  • Salvatore Cucchiara
Gastrointestinal

Abstract

Objectives

To identify differences between two cohorts of adult and pediatric patients affected by Crohn’s disease (CD), with regard to lesion location in the small intestine and colon-rectum, lesion activity, and prevalence of perianal disease (PD), using MRI as the main diagnostic tool.

Methods

We retrospectively reviewed 350 consecutive MRI examinations performed between 2013 and 2016 in outpatients or inpatients with histologically proven CD, monitored by the Gastroenterology and Pediatric Units of our Hospital. The magnetic resonance enterography (MRE) protocol for adult and pediatric CD patients routinely includes evaluation of nine different intestinal segments (from jejunum to rectum) and of the anal canal. Intestinal activity was also calculated using a validated score. Perianal disease (PD) was staged. Fisher’s exact test was used and the odds ratio (OR) was calculated.

Results

Two hundred and nineteen out of 350 MRI studies (118 adults and 101 children) were included. The prevalence of PD was 34.6% in children and 16.1% in adults (OR = 2.8; p = 0.0017). Pediatric patients showed more frequent rectal involvement (29.7% vs 13.5%, OR = 2.7; p = 0.0045) and higher risk of PD in the presence of rectal disease (p = 0.043; OR = 4.5). In pediatric patients with severe colorectal disease, the prevalence of PD was twofold (86.7% vs 40%; p = 0.072). Using the clinical Montreal classification for lesion location, no significant differences emerged between the two patient populations.

Conclusions

MRI showed a significantly higher prevalence of rectal involvement and perianal disease in the pediatric population. These results may have a relevant clinical impact and deserve further investigation.

Key Points

• To our knowledge, this is the largest morphological comparative study available in the literature using MRI as the main diagnostic tool to compare adult patients and children with Crohn’s disease.

• Our study showed significant differences between adults and children: a higher prevalence of rectal and perianal fistulous disease (PD) in pediatric patients and an increased prevalence of PD in the presence of severe colon-rectum involvement.

• The association of rectal and perianal disease implies a poorer clinical prognosis and a higher risk of disabling complications in pediatric patients.

Keywords

Magnetic resonance imaging Crohn disease Pediatrics Fistula Anal canal 

Abbreviations

CD

Crohn’s disease

CI

Confidence interval

DWI

Diffusion-weighted imaging

HASTE

Half-Fourier acquisition single shot turbo spin echo

HRMRI

High-resolution magnetic resonance imaging

MEGS

Magnetic resonance enterography global score

MRE

Magnetic resonance enterography

MRI

Magnetic resonance imaging

OR

Odds ratio

PD

Perianal disease

SJH

St. James Hospital

TrueFISP

True fast imaging with steady-state free precession

VIBE

Volumetric interpolated breath-hold examination

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Francesca Maccioni.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2019_6006_MOESM1_ESM.doc (62 kb)
ESM 1 (DOC 61 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Francesca Maccioni
    • 1
    Email author
  • Davide Bencardino
    • 1
  • Valeria Buonocore
    • 1
  • Fabrizio Mazzamurro
    • 1
  • Franca Viola
    • 2
  • Salvatore Oliva
    • 2
  • Piero Vernia
    • 3
  • Manuela Merli
    • 4
  • Anna Rita Vestri
    • 5
  • Carlo Catalano
    • 1
  • Salvatore Cucchiara
    • 2
  1. 1.Department of Radiological SciencesOncology and Pathology, Sapienza University of Rome, Policlinico Umberto I Hospital RomeItaly
  2. 2.Department of Pediatrics and Pediatric NeuropsychiatrySapienza University of Rome, Policlinico Umberto I HospitalRomeItaly
  3. 3.Department of Internal Medicine and Medical Specialties, Gastroenterology UnitSapienza University of Rome, Policlinico Umberto I HospitalRomeItaly
  4. 4.Gastroenterology, Department of Clinical MedicineSapienza University of Rome, Policlinico Umberto I HospitalRomeItaly
  5. 5.Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly

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