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Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E

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Abstract

Symptoms of Crohn’s disease (CD) can be due to active inflammation or fibrosis. Differentiating these based on clinical presentation, endoscopy, laboratory parameters, and clinical scoring methods can be inaccurate and/or invasive. As therapy decisions are often directed based on whether active disease or fibrosis is present, a reliable and non-invasive test to distinguish these two etiologies would be a powerful clinical tool. CT enterography (CT-E) and MR enterography (MR-E) are two non-invasive imaging modalities tailored to evaluate the small bowel. The purpose of our study was to compare the ability of MR-E and CT-E to assess for active inflammation and mural fibrosis in patients with known CD as compared to a histologic reference standard. After obtaining MR-E and CT-E on the same day, a total of 61 histologic samples were obtained from twelve subjects aged 12–20 years via full-thickness bowel resection or endoscopy. These were evaluated by the pathologist for active inflammation and fibrosis. We found that while CT-E and MR-E were similar in their accuracies of depicting active inflammation, MR-E was significantly more sensitive in detecting fibrosis. Because of this and the lack of ionizing radiation from MR-E, we believe that MR-E rather than CT-E should serve as the primary imaging modality for the assessment of CD pediatric patients with non-acute clinical exacerbations.

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Acknowledgments

Supported by a Clinical and Translational Science Award UL1 RR025758-02 (to M.S.G.) from Harvard Medical School and the National Institutes of Health.

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Authors and Affiliations

  1. Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Keith B. Quencer, Katherine Nimkin, Mari Mino-Kenudson & Michael S. Gee

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  1. Keith B. Quencer
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  2. Katherine Nimkin
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  3. Mari Mino-Kenudson
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  4. Michael S. Gee
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Correspondence to Keith B. Quencer.

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Quencer, K.B., Nimkin, K., Mino-Kenudson, M. et al. Detecting active inflammation and fibrosis in pediatric Crohn’s disease: prospective evaluation of MR-E and CT-E. Abdom Imaging 38, 705–713 (2013). https://doi.org/10.1007/s00261-013-9981-z

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