OBJECTIVES The objectives of this study were prospective evaluation of MR enterographic accuracy for detecting Crohn's disease imaging features in pediatric patients compared with a CT reference standard, as well as determination of MR enterographic accuracy for detecting active bowel inflammation and fibrosis using a histologic reference standard. MATERIALS AND METHODS The study group for this blinded prospective study included 21 pediatric subjects with known Crohn's disease scheduled for clinical CT imaging and histological bowel sampling for symptomatic exacerbation. All subjects and their parents gave informed consent to also undergo MR enterography. CT and MR enterography examinations were independently reviewed by 2 radiologists and scored for Crohn's disease features. All bowel histology specimens were reviewed by a single pathologist for presence of active mucosal inflammation and mural fibrosis, followed by imaging-histological correlation. RESULTS All 21 subjects underwent MR enterography and histological sampling, 18 of whom also underwent CT. MR enterography demonstrated high sensitivity for detecting Crohn's imaging features (bowel wall thickening, mesenteric inflammation, lymphadenopathy, fistula, abscess) compared with CT, with individual sensitivity values ranging from 85.1-100%. Out of a total of 53 abnormal bowel segments with MRI-histology correlation, MR enterography demonstrated 86.7% accuracy (90.0% sensitivity, 82.6% specificity) for detecting active inflammation (P < 0.001). Accuracy of MR enterography for detecting mural fibrosis overall was 64.9% compared with histology, but increased to 88.2% (P < 0.05) for detecting fibrosis without superimposed active inflammation. CONCLUSIONS MR enterography can substitute for CT as the first-line imaging modality in pediatric Crohn's patients, based on its ability to detect intestinal pathology in both small and large bowel as well as extraintestinal disease manifestations. Additionally, MR enterography provides an accurate noninvasive assessment of Crohn's disease activity and mural fibrosis and can aid in formulating treatment strategies for symptomatic patients and assessing therapy response.

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Patients who have undergone repair of esophageal atresia and tracehoesophageal fistula as infants have been noted to have residual esophageal dysmotility and pulmonary dysfunction during their childhood years. However, limited information is available about the long-term follow-up of these patients. In this study we performed esophageal and pulmonary function studies on 12 adults who had required surgical repair of these defects in the first week of life. Most patients had symptoms of dysphagia and heartburn at time of evaluation. Pathologic gastroesophageal reflux was documented in 67% of patients and esophagitis was noted in 34%. All patients had esophageal motility abnormalities characterized by low-amplitude nonperistaltic waves throughout most of the esophagus. In addition, although most patients had no respiratory symptoms, mild restrictive lung volumes were noted in many patients. However, airflow obstruction and airway hyperreactivity were not present. These data demonstrate that clinical symptoms and abnormal esophageal manometry and pulmonary function persist well into the third and beginning of the fourth decade after repair of esophageal atresia and tracheoesophageal fistula in infancy.