Abstract
Background
While MR enterography (MRE) is commonly used to identify segments of bowel affected by Crohn disease in children, there is little data to support this practice.
Objective
To assess the ability of MRE to identify segments of small bowel and colon affected by pediatric Crohn disease using histopathology as the reference standard.
Materials and methods
Pediatric MRE examinations performed between April 2009 and December 2010 were identified. Subjects were excluded if they did not have Crohn disease, if they had Crohn disease but no correlative histopathology within 2 months of imaging, or if they had undergone prior bowel resection. Pertinent MRE and histopathology reports were reviewed, and normal and abnormal bowel segments were documented.
Results
Thirty-two pediatric MRE examinations were identified with correlative histopathology. MRE had an overall sensitivity of 94% for detecting the presence of Crohn disease, in general. At the bowel segmental level, MRE had a sensitivity of 66%, specificity of 90%, positive predictive value of 85% and negative predictive value of 76%. The terminal ileum was abnormal by MRE in 11 of 15 (73%) subjects lacking a diagnostic biopsy of this bowel segment.
Conclusion
MRE successfully identifies small bowel and colon segments affected by pediatric Crohn disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Malaty HM, Fan X, Opekun AR et al (2010) Rising incidence of inflammatory bowel disease among children: a 12-year study. J Pediatr Gastroenterol Nutr 50:27–31
Diefenbach KA, Breuer CK (2006) Pediatric inflammatory bowel disease. World J Gastroenterol 12:3204–3212
Heyman MB, Kirschner BS, Gold BD et al (2005) Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr 146:35–40
Vucelic B (2009) Inflammatory bowel diseases: controversies in the use of diagnostic procedures. Dig Dis 27:269–277
Dillman JR, Adler J, Zimmermann EM et al (2010) CT enterography of pediatric Crohn disease. Pediatr Radiol 40:97–105
Paolantonio P, Ferrari R, Vecchietti F et al (2009) Current status of MR imaging in the evaluation of IBD in a pediatric population of patients. Eur J Radiol 69:418–424
Godefroy C, Pilleul F, Dugougeat F et al (2005) Value of contrast-enhanced MR enterography in pediatric Crohn’s disease: preliminary study. J Radiol 86:1685–1692
Alexopoulou E, Roma E, Loggitsi D et al (2009) Magnetic resonance imaging of the small bowel in children with idiopathic inflammatory bowel disease: evaluation of disease activity. Pediatr Radiol 39:791–797
Adler J, Higgins PD (2010) Getting the steak without the sizzle: is MR enterography as good as CT enterography? Inflamm Bowel Dis 16:712–713
Darbari A, Sena L, Argani P et al (2004) Gadolinium-enhanced magnetic resonance imaging: a useful radiological tool in diagnosing pediatric IBD. Inflamm Bowel Dis 10:67–72
Darge K, Anupindi SA, Jaramillo D (2008) MR imaging of the bowel: pediatric applications. Magn Reson Imaging Clin N Am 16:467–478
Dinkel E, Dittrich M, Peters H et al (1986) Real-time ultrasound in Crohn’s disease: characteristic features and clinical implications. Pediatr Radiol 16:8–12
Faure C, Belarbi N, Mougenot JF et al (1997) Ultrasonographic assessment of inflammatory bowel disease in children: comparison with ileocolonoscopy. J Pediatr 130:147–151
Haber HP, Busch A, Ziebach R (2000) Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. Lancet 355:1239–1240
Scholbach T, Herrero I, Scholbach J (2004) Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects. J Pediatr Gastroenterol Nutr 39:524–528
Bremner AR, Pridgeon J, Fairhurst J et al (2004) Ultrasound scanning may reduce the need for barium radiology in the assessment of small-bowel Crohn’s disease. Acta Paediatr 93:479–481
Alison M, Kheniche A, Azoulay R et al (2007) Ultrasonography of Crohn disease in children. Pediatr Radiol 37:1071–1082
Bremner AR, Griffiths M, Argent JD et al (2006) Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study. Pediatr Radiol 36:947–953
Brenner DJ (2008) Should computed tomography be the modality of choice for imaging Crohn’s disease in children? The radiation risk perspective. Gut 57:1489–1490
Lipson A, Bartram CI, Williams CB et al (1990) Barium studies and ileoscopy compared in children with suspected Crohn’s disease. Clin Radiol 41:5–8
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 251:751–761
Calhoun BC, Gomes F, Robert ME et al (2003) Sampling error in the standard evaluation of endoscopic colonic biopsies. Am J Surg Pathol 27:254–257
Schreyer AG, Rath HC, Kikinis R et al (2005) Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 54:250–256
Ali SI, Carty HM (2000) Paediatric Crohn’s disease: a radiological review. Eur Radiol 10:1085–1094
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dillman, J.R., Ladino-Torres, M.F., Adler, J. et al. Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol 41, 1552–1558 (2011). https://doi.org/10.1007/s00247-011-2186-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-011-2186-0