ULTRASOUND AND MAGNETIC RESONANCE ENTEROGRAPHY IN DIAGNOSIS OF CROHN’S DISEASE IN CHILDREN
Abstract
Abstract
Introduction
Crohn's disease is a chronic inflammatory bowel disease, which is characterized by remitting and relapsing episodes, and commonly affects young adults. MR enterography (MRE) and US are taking the leading role in diagnostics, initial estimation of Crohn’s disease and monitoring of activity, detection and evaluation of complications.
Aim
To examine SE, SP, PPV, NPV of US and MRE in diagnosis of Crohn’s disease. Also, to examine overall diagnostic value of MRE comparing the morphological and functional parameters with the endoscopical findings.
Material and methods
40 patients were observed from the end of year 2009 to the end of 2016. Diagnosed patients with clinical and laboratory findings were sent for US and MRE examination. US evaluated wall thickness, fibrofatty proliferation and enlargement of mesenteric lymph nodes. Besides this, MRE also evaluated bowel wall enhancement and layered enhancement pattern.
Results
Overall diagnostic value of morphological and functional parameters on the MRE has a SE of 58.3% and SP of 100% if we want to confirm the diagnosis, and SE 87.5% and SP of 80% if we want to exclude the diagnosis. There was statistically significant correlation between the increased wall thickness and the accumulation of fat in the mesentery on MRE, and the gold standard.
Correlation between results on US and MRE shows statistical significance in ileum, terminal ileum, Bauchini valve and cecum, ascendant colon. It showed high specificity (SP) for both diagnostic procedures in almost all segments (maximum value 94,7%). Sensitivity (SE) varied from 0 to 83,3% in different bowel segments.
Conclusion
Our study showed that it is reliable to use MRE and US to exclude those who don’t have Crohn’s disease. Also, combination of morphological and functional parameters on MRE could be used in confirming and monitoring Crohn’s disease.
Key words: Crohn’s disease, children, magnetic resonance enterography, ultrasound
References
Loftus EV Jr, Schoenfeld P, Sandborn WJ. The epidemiology and natural history of Crohn’s diseasein population-based patient cohorts from NorthAmerica: a systematic review. Aliment Pharmacol Ther 2002; 16:51–60.
Cosnes, J. et al. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 2012; 140:1785-1794.
Loftus, EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004; 126:1504-1517.
Abraham, C. & Cho, J.H. Inflammatory bowel disease. N. Engl. J. Med. 2009; 361:2066- 2078.
Kichul Yoon, Kyu-Tae Chang, and Hong J. Lee, Review Article MRI for Crohn’s Disease: Present and Future. BioMed Research International 2015; 786802.
Panes J, Bouzas R, Chaparro M, Garcia-Sanchez V, Gisbert JP, Martinez de GB, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther 2011; 34(2):125-45.
Florie J, Horsthuis K, Hommes DW, Nio CY, Reitsma JB, van Deventer SJ, et al. Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn’s disease. Clin Gastroenterol Hepatol 2005; 3:1221-1228.
Leyendecker J, Bloomfeld R, DiSantis J, Waters G, Mott R, Bechtold R. MR enterigraphy in the management of patients with Crohn disease. Radio Graphics 2009; 29:1827-1846.
Sauer CG, Middleton JP, Alazraki A, Udayasankar UK, Kalb B, Applegate KE, et al. Comparison of magnetic resonance enterography with endoscopy, histopathology, and laboratory evaluation in pediatric Crohn disease. J Pediatr Gastroenterol Nutr 2012; 55:178–184.
Golder SK, Schreyer AG, Endlicher E, Feuerbach S, Scholmerich J, Kullmann F, et al. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small boweldisease. Int J Colorectal Dis 2006; 21:97–107.
Ahmad T, Greer ML, Walters T, Navarro O. Bowel sonography and MR enterography in children. AJR Am J Roentgenol 2016; 206(1):173-81.
Stuart S, Conner T, Ahmed A, Steward M, Maclachlan J, Wylie P, Beal I. The smaller bowel: imaging the small bowel in paediatric Crohn’s disease. Postgrad Med J 2011; 87: 288-297.
Casciani E, De Vincentiis C, Polettini E, Masselli G et al. Imaging of the small bowel: Crohn’s disease in paediatric patients, World J Radiol 2014; 6:313-328.
Poza-Cordón J, Ripollés-González T. Utility of abdominal ultrasonography in the diagnosis and monitoring of inflammatory bowel disease. Rev Esp Enferm Dig 2014; 106:395-408.
Schreyer AG, Rath HC, Kikinis R, et al. Comparison of magnetic resonance imaging colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut 2005; 54:250–6.
Koh DM, Miao Y, et al. MR Imaging Evaluation of the Activity of Crohn’s Disease. AJR Am J Roentgenol 2001; 6:132532.
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Prassopoulos P. MR enteroclysis: technical considerations and clinical applications. Eur Radiol 2002; 12:2651–2658.
Desai RK, Tagliabue JR, Wegryn SA, et al. CT evaluation of wall thickening in the alimentary tract. RadioGraphics 1991; 11:771–783.
Balthazar EJ. CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 1991; 156:23–32.
Macari M, Balthazar EJ. CT of bowel wall thickening: significance and pitfalls of interpretation. AJR Am J Roentgenol 2001; 176:1105–1116.
Low RN, Sebrechts CP, Politoske DA, et al. Crohn disease with endoscopic correlation: singleshot fast spin-echo and gadolinium-enhanced fatsuppressedspoiled gradient-echo MR imaging. Radiology 2002; 222:652–660.
Turetschek K, Schober E, Wunderbaldinger P, et al. Findings at helical CT-enteroclysis in symptomatic patients with Crohn’s disease: correlation with endoscopic and surgical findings. J Comput Assist Tomogr 2002; 26:488–492.
Shoenut JP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB. Magnetic resonance imaging in inflammatory bowel disease. J Clin Gastroenterol 1993; 17:73–78.
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M. Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. European Radiology 2004. 14:1017-1024.
Dušan Vukićević, Marko Svetel, Nataša Stanković, Jelena Kovač MR enterokliza u evaluaciji i praćenju pacijenata sa Kronovom bolešću, Medicinski podmladak 2014.
Furukawa A, Saotome T, Yamasaki M, et al. Crosssectional imaging in Crohn disease. RadioGraphics 2004; 24:689–702.
J. Rimola, S. Rodriguez, O. Garcia-Bosch et al., Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease, Gut 2009; 58:1113–1120.
Ziech ML, Hummel TZ, Smets AM, Nievelstein RA, Lavini C, Caan MW, et al, Accuracy of abdominal ultrasound and MRI for detection of Crohn's disease and ulcerative colitis in children. Pediatr Radiol. 2014; 44:1370–1378.
Pallotta N, Tomei E, Viscido A, Calabrese E, Marcheggiano A, Caprilli R, et al., Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease. Inflamm Bowel Dis 2005; 11: 146-153.
Nylund K, Hausken T, Gilja OH. Ultrasound and inflammatory bowel disease. Ultrasound Q 2010; 26:3-15.
Truong M, Atri M, Bret PM, Reinhold C, Kintzen G, Thibodeau M, et al. Sonographic appearance of benign and malignant conditions of the colon. AJR Am J Roentgenol 1998; 170:1451-5.
Kumar S, Hakim A, Alexakis C, Chhaya V, Tzias D, Pilcher J, et al. Small intestinal contrast ultrasonography for the detection of small bowel complications in Crohn’s disease: correlation with intraoperative findings and magnetic resonance enterography. J Gastroenterol Hepatol 2015; 30:86–91.
Darge K, Anupindi S, Keener H, Rompel O. Ultrasound of the bowel in children: how we do it. Pediatr Radiol 2010; 40:528–536.