Abstract
Background
Assessment for active Crohn disease by CT enterography and MR enterography relies on identifying mural and perienteric imaging features.
Objective
To evaluate the performance of established imaging features of active Crohn disease in children and adolescents on CT and MR enterography compared with histological reference.
Materials and methods
We included patients ages 18 years and younger who underwent either CT or MR enterography from 2007 to 2014 and had endoscopic biopsy within 28 days of imaging. Two pediatric radiologists blinded to the histological results reviewed imaging studies and scored the bowel for the presence or absence of mural features (wall thickening >3 mm, mural hyperenhancement) and perienteric features (mesenteric hypervascularity, edema, fibrofatty proliferation and lymphadenopathy) of active disease. We performed univariate analysis and multivariate logistic regression to compare imaging features with histological reference.
Results
We evaluated 452 bowel segments (135 from CT enterography, 317 from MR enterography) from 84 patients. Mural imaging features had the highest association with active inflammation both for MR enterography (wall thickening had 80% accuracy, 69% sensitivity and 91% specificity; mural hyperenhancement had 78%, 53% and 96%, respectively) and CT enterography (wall thickening had 84% accuracy, 72% sensitivity and 91% specificity; mural hyperenhancement had 76%, 51% and 91%, respectively), with perienteric imaging features performing significantly worse on MR enterography relative to CT enterography (P < 0.001).
Conclusion
Mural features are predictors of active inflammation for both CT and MR enterography, while perienteric features can be distinguished better on CT enterography compared with MR enterography. This likely reflects the increased conspicuity of the mesentery on CT enterography and suggests that mural features are the most reliable imaging features of active Crohn disease in children and adolescents.
Similar content being viewed by others
References
Floyd DN, Langham S, Séverac HC et al (2015) The economic and quality-of-life burden of Crohn's disease in Europe and the United States, 2000 to 2013: a systematic review. Dig Dis Sci 60:299–312
Benchimol EI, Fortinsky KJ, Gozdyra P et al (2011) Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 17:423–439
Baumgart DC, Carding SR (2007) Inflammatory bowel disease: cause and immunobiology. Lancet 369:1627–1640
Loftus EV Jr (2004) Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 126:1504–1517
Diefenbach KA, Breuer CK (2006) Pediatric inflammatory bowel disease. World J Gastroenterol 12:3204–3212
Maglinte DD, Gourtsoyiannis N, Rex D et al (2003) Classification of small bowel Crohn’s subtypes based on multimodality imaging. Radiol Clin N Am 41:285–303
Clark M, Colombel JF, Feagan BC et al (2007) American Gastroenterological Association consensus development conference on the use of biologics in the treatment of inflammatory bowel disease, June 21–23, 2006. Gastroenterography 133:312–339
Spinelli A, Correale C, Szabo H et al (2010) Intestinal fibrosis in Crohn's disease: medical treatment or surgery? Curr Drug Targets 11:242–248
Anupindi SA, Grossman AB, Nimkin K et al (2014) Imaging in the evaluation of the young patient with inflammatory bowel disease: what the gastroenterologist needs to know. J Pediatr Gastroenterol Nutr 59:429–439
Martin DR, Lauenstein T, Sitaraman SV (2007) Utility of magnetic resonance imaging in small bowel Crohn's disease. Gastroenterology 133:385–390
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
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
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
Dillman JR, Adler J, Zimmermann EM et al (2010) CT enterography of pediatric Crohn disease. Pediatr Radiol 40:97–105
Oommen J, Oto A (2011) Contrast-enhanced MRI of the small bowel in Crohn’s disease. Abdom Imaging 36:134–141
Anupindi SA, Podberesky DJ, Towbin AJ et al (2015) Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging 40:975–992
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
Smolinski S, George M, Dredar A et al (2014) Magnetic resonance enterography in evaluation and management of children with Crohn's disease. Semin Ultrasound CT MR 35:331–348
Qiu Y, Mao R, Chen BL et al (2014) Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease. Aliment Pharmacol Ther 40:134–146
Mollard BJ, Smith EA, Lai ME et al (2016) MR enterography under the age of 10 years: a single institutional experience. Pediatr Radiol 46:43–49
Kilcoyne A, Kaplan JL, Gee MS (2016) Inflammatory bowel disease imaging: current practice and future directions. World J Gastroenterol 22:917–932
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
Singh S, Kalra MK, Moore MA et al (2009) Dose reduction and compliance with pediatric CT protocols adapted to patient size, clinical indication, and number of prior studies. Radiology 252:200–208
Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464
Efron B (1979) Bootstrap methods: another look at the jackknife. Ann Stat 7:1–26
The R Foundation (2013) R: a language and environment for statistical computing. The R Foundation for Statistical Computing, Vienna. http://www.R-project.org/. Accessed 1 Mar 2017
Huprich JE, Rosen MP, Fidler JL et al (2010) ACR appropriateness criteria on Crohn's disease. J Am Coll Radiol 7:94–102
Hammer MR, Podberesky DJ, Dillman JR (2013) Multidetector computed tomographic and magnetic resonance enterography in children: state of the art. Radiol Clin N Am 51:615–636
Makanyanga JC, Taylor SA (2013) Current and future role of MR enterography in the management of Crohn disease. AJR Am J Roentgenol 201:56–64
Duigenan S, Gee MS (2012) Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol 199:907–915
Towbin AJ, Sullivan J, Denson LA et al (2013) CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics 33:1843–1860
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None
Rights and permissions
About this article
Cite this article
Gale, H.I., Sharatz, S.M., Taphey, M. et al. Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol 47, 1321–1328 (2017). https://doi.org/10.1007/s00247-017-3876-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00247-017-3876-z