Abstract
MR enterography (MRE) has become the primary imaging modality for assessing Crohn disease in young patients because of its lack of ionizing radiation, superior soft-tissue contrast, and cross-sectional capability to evaluate disease activity as well as extraluminal and extra-intestinal complications. MRE has been extensively validated against both histological and endoscopic references as a noninvasive imaging biomarker of Crohn disease activity. More recent studies have also validated MRE as a noninvasive biomarker of mucosal healing, an important endpoint of Crohn disease therapy. In this review, we summarize the current evidence supporting the use of MRE features as imaging biomarkers of Crohn disease activity and treatment response.
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References
Rubesin SE, Scotiniotis I, Birnbaum BA et al (2001) Radiologic and endoscopic diagnosis of Crohn’s disease. Surg Clin North Am 81:39–70
Kappelman MD, Moore KR, Allen JK et al (2013) Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci 58:519–525
Desmond AN, O’Regan K, Curran C et al (2008) Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation. Gut 57:1524–1529
AlSabban Z, Carman N, Moineddin R et al (2017) Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease? J Magn Reson Imaging. https://doi.org/10.1002/jmri.25888
Sauer CG, Kugathasan S, Martin DR et al (2011) Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses. Inflamm Bowel Dis 17:2326–2332
Kordbacheh H, Baliyan V, Serrao J et al (2017) Imaging in patients with Crohn’s disease: trends in abdominal CT/MRI utilization and radiation exposure considerations over a 10-year period. Inflamm Bowel Dis 23:1025–1033
Moy MP, Sauk J, Gee MS (2016) The role of MR enterography in assessing Crohn’s disease activity and treatment response. Gastroenterol Res Pract 2016:8168695
Greer M-LC (2016) How we do it: MR enterography. Pediatr Radiol 46:818–828
Anupindi SA, Terreblanche O, Courtier J (2013) Magnetic resonance enterography. Magn Reson Imaging Clin N Am 21:731–750
Dillman JR, Smith EA, Khalatbari S et al (2013) IV glucagon use in pediatric MR enterography: effect on image quality, length of examination, and patient tolerance. AJR Am J Roentgenol 201:185–189
Dillman JR, Trout AT, Smith EA (2016) MR enterography: how to deliver added value. Pediatr Radiol 46:829–837
Gale HI, Sharatz SM, Taphey M et al (2017) Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol 47:1321–1328
Church PC, Greer MLC, Cytter-Kuint R et al (2017) Magnetic resonance enterography has good inter-rater agreement and diagnostic accuracy for detecting inflammation in pediatric Crohn disease. Pediatr Radiol 47:565–575
Dillman JR, Ladino-Torres MF, Adler J et al (2011) Comparison of MR enterography and histopathology in the evaluation of pediatric Crohn disease. Pediatr Radiol 41:1552–1558
Gee MS, Nimkin K, Hsu M et al (2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR Am J Roentgenol 197:224–231
Wallihan DB, Towbin AJ, Denson LA et al (2012) Inflammatory bowel disease in children and adolescents. Assessing the diagnostic performance and interreader agreement of magnetic resonance enterography compared to histopathology. Acad Radiol 19:819–826
Absah I, Bruining DH, Matsumoto JM et al (2012) MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image quality, and initial performance estimates. AJR Am J Roentgenol 199:367–375
Maccioni F, Al Ansari N, Mazzamurro F et al (2014) Detection of Crohn disease lesions of the small and large bowel in pediatric patients: diagnostic value of MR enterography versus reference examinations. AJR Am J Roentgenol 203:W533–W542
Quencer KB, Nimkin K, Mino-Kenudson M et al (2013) Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38:705–713
Siddiki HA, Fidler JL, Fletcher JG et al (2009) Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 193:113–121
Lee SS, Kim AY, Yang S-K 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
Rimola J, Ordás I, Rodriguez S et al (2011) Magnetic resonance imaging for evaluation of Crohn’s disease: validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 17:1759–1768
Steward MJ, Punwani S, Proctor I et al (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088
Makanyanga JC, Pendsé D, Dikaios N et al (2014) Evaluation of Crohn’s disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 24:277–287
Pariente B, Mary J-Y, Danese S et al (2015) Development of the Lémann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology 148:52–63
Fiorino G, Danese S (2016) Adalimumab and azathioprine combination therapy for Crohn’s disease: a shining diamond? J Crohn's Colitis 10:1257–1258
Cohen BL, Sachar DB (2017) Update on anti-tumor necrosis factor agents and other new drugs for inflammatory bowel disease. BMJ 357:j2505
Dillman JR, Carlos RC, Smith EA et al (2016) Relationship of bowel MR imaging to health-related quality of life measures in newly diagnosed pediatric small bowel Crohn disease. Radiology 280:568–575
Osterman MT (2013) Mucosal healing in inflammatory bowel disease. J Clin Gastroenterol 47:212–221
Olaison G, Smedh K, Sjödahl R (1992) Natural course of Crohn’s disease after ileocolic resection: endoscopically visualised ileal ulcers preceding symptoms. Gut 33:331–335
Frøslie KF, Jahnsen J, Moum BA et al (2007) Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 133:412–422
Solberg IC, Lygren I, Jahnsen J et al (2008) Mucosal healing after initial treatment may be a prognostic marker for long-term outcome in inflammatory bowel disease. Gut 57:A15
Baert F, Moortgat L, Van Assche G et al (2010) Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterology 138:463–468
Schnitzler F, Fidder H, Ferrante M et al (2009) Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. Inflamm Bowel Dis 15:1295–1301
af Björkesten CG, Nieminen U, Sipponen T et al (2013) Mucosal healing at 3 months predicts long-term endoscopic remission in anti-TNF-treated luminal Crohn’s disease. Scand J Gastroenterol 48:543–551
Colombel JF, Rutgeerts P, Sandborn W et al (2010) Achievement of early deep remission predicts better long-term outcomes for adalimumab-treated patients with Crohn’s disease: data from EXTEND. Am J Gastroenterol 105:S434–S435
Nuti F, Civitelli F, Bloise S et al (2016) Prospective evaluation of the achievement of mucosal healing with anti-TNF-α therapy in a paediatric Crohn’s disease cohort. J Crohn's Colitis 10:5–12
Rismo R, Olsen T, Ciu G et al (2012) The effect of adalimumab for induction of endoscopic healing and normalization of mucosal cytokine gene expression in Crohn’s disease. Scand J Gastroenterol 47:1200–1210
Ruemmele FM, Hyams JS, Otley A et al (2015) Outcome measures for clinical trials in paediatric IBD: an evidence-based, expert-driven practical statement paper of the paediatric ECCO committee. Gut 64:438–446
Rutgeerts P, Van Assche G, Sandborn WJ et al (2012) Adalimumab induces and maintains mucosal healing in patients with Crohn’s disease: data from the EXTEND trial. Gastroenterology 142:1102–1111
Ordás I, Rimola J, Rodríguez S et al (2014) Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn’s disease. Gastroenterology 146:374–382
Moy MP, Kaplan JL, Moran CJ et al (2016) MR enterographic findings as biomarkers of mucosal healing in young patients with Crohn disease. AJR Am J Roentgenol 207:896–902
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Mojtahed, A., Gee, M.S. Magnetic resonance enterography evaluation of Crohn disease activity and mucosal healing in young patients. Pediatr Radiol 48, 1273–1279 (2018). https://doi.org/10.1007/s00247-018-4107-y
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DOI: https://doi.org/10.1007/s00247-018-4107-y