Magnetic resonance enterography guiding treatment in children with Crohn’s jejunoileitis

Piekkala, Maija; Kalajoki-Helmiö, Teija; Martelius, Laura; Pakarinen, Mikko P.; Rintala, Risto; Kolho, Kaija-Leena

doi:10.1111/j.1651-2227.2012.02607.x

Cited by 7 publications

(5 citation statements)

References 23 publications

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“…MRE has been found to have a sensitivity of 83 to 94 per cent and specificity of 90 to 100 per cent for detecting CD in several studies. [7][8][9] In a prospective study of 50 patients with symptomatic CD, there was no significant difference between the sensitivity and specificity of MRE compared with that of CT in detecting the presence of small bowel CD. 10 Furthermore, it was concluded that although both MRE and CT have high positive predictive values for detecting CD (93 and 91%, respectively), the negative predictive values (47 and 54%, respectively) are low.…”

Section: Discussionmentioning

confidence: 95%

“…7 Although it does not detect superficial lesions, MRE can detect stenoses, thickening, and hyperemia of the bowel wall, extramural complications, and abscesses. 8 Furthermore, magnetic resonance imaging (MRI) is excellent at differentiating active inflammation from fibrosis in a thickened bowel segment. This is important for patient management because fibrotic stenosis often requires operative intervention, whereas active inflammation can respond to medical management.…”

Section: Discussionmentioning

confidence: 99%

“…They proposed that patients with little or no inflammatory changes on MRE can be managed with no change in current treatment, patients with findings of chronic CD are likely to be managed surgically, and patients with extensive active inflammation are likely to require aggressive medical management. Piekkala et al 8 performed a similar study in children and found that 74 per cent were managed medically based on MRI findings, and 26 per cent required operative intervention. Seventy-three per cent of the patients who underwent surgery had intraoperative findings consistent with the MRI results.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

Litz

Danielson

Wilsey

et al. 2013

The American Surgeon™

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Crohn's disease (CD) is a chronic illness and radiographic evaluation is frequently used. Consequently, pediatric patients with CD who are diagnosed in childhood are at risk for high levels of radiation exposure during their lifetimes. We sought to evaluate the impact of magnetic resonance enterography (MRE) in management of pediatric patients with known or suspected Crohn's disease. A retrospective review of patients with known or suspected CD who underwent MRE for new onset of symptoms was conducted. All demographic data, clinical history, and results of all radiographic, endoscopic, and pathology studies were recorded. Twenty-eight patients with known or suspected CD underwent 31 MRE examinations. MRE showed active disease in 16 (52%), fistula or abscess in seven (22%), and no evidence of active disease in eight (26%). Sixty-five per cent of patients underwent MRE with no other radiation-based imaging used. Surgical intervention was deemed necessary after the MRE in 16 per cent. In all cases, surgical findings were consistent with MRE results. Nearly 60 per cent of patients with CD are managed based on the findings of MRE without additional radiographic evaluation. Based on the results of this retrospective study, we propose a clinical pathway for use of MRE in patients with known or suspected CD with new onset of symptoms.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

Litz

Danielson

Wilsey

et al. 2013

The American Surgeon™

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“…Radiological imaging is an important non-invasive method for the diagnosis of UC. Compared with CT, MRI has several advantages, such as high-resolution imaging, detailed soft tissue background, and no need for ionizing radiation [19][20][21]. With a higher spatial resolution and multi-parameter imaging, MRI is suitable for the early diagnosis of UC and assessment of disease activity [22].…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance colonography with intestine-absorbable nanoparticle contrast agents in evaluation of colorectal inflammation

et al. 2021

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Objectives To develop a nanoparticle-based MRI protocol based on transrectal administration of intestine-absorbable nanoparticle contrast agents to evaluate ulcerative colitis (UC). Methods Solid lipid nanoparticles (SLNs) were synthesized by loading gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) and octadecylamine-fluorescein isothiocyanate to produce Gd-FITC-SLNs as T1 contrast agents. Twenty mice with acute UC were divided into four groups: enema with Gd-FITC-SLNs, intravenous injection of Gd-FITC-SLNs, enema with Gd-DTPA, and intravenous injection of Gd-DTPA. Five mice with chronic UC and five mice without UC underwent enema with Gd-FITC-SLNs. Axial T1- and T2-weighted MR images were obtained before and 20, 40, 60, 80,100, and 120 min after enema or intravenous injection of the contrast agent. The signal-to-noise ratios (SNRs) of the colorectal wall were measured in both groups. The MRI findings were correlated with subsequent histological confirmation. Results At 20 min after enema with Gd-FITC-SLNs, MRI showed the following contrast enhancement pattern: acute UC > normal intestinal wall > chronic UC. A continuous enhancement effect was observed in mice with acute UC, whereas a slight continuous enhancement of the colorectal wall was observed in mice with chronic UC. The normal intestinal wall rapidly metabolized the contrast agent, and the enhancement decreased on sequential scans. There was no significant difference between the SNRs of the intestinal wall at 20 min after intravenous Gd-DTPA and transrectal Gd-FITC-SLN administration. Conclusions Enema with Gd-FITC-SLNs may be helpful for the diagnosis and differential diagnosis of acute and chronic UC and can confer the same or better results than with intravenous Gd-DTPA. Key Points • Enema with Gd-FITC-SLNs may be helpful for the diagnosis and differential diagnosis of acute and chronic UC. • Enema with Gd-FITC-SLNs can achieve the same or better result than that with intravenous Gd-DTPA. • SLN-based MR colonography enhances the colorectal wall inflammation, based on the colonic absorption of the nanoparticle contrast agents.

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“…So far, magnetic resonance (MR) enterography has gained a central role in imaging pediatric IBD of disease activity [96]. In some reports the findings in MR enterography (MRE) images have probably overestimated inflammation, when compared to findings detected while at surgery [101]. However, the published data on MR investigations for pediatric IBD patients has mostly been restricted to patients with Crohn´s disease [96][97][98][99][100].…”

Section: Improvements In Imagingmentioning

confidence: 99%

Progress in the treatment and outcome of pediatric inflammatory bowel disease patients

Kolho

Ainamo

2016

Expert Review of Clinical Immunology

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The number of pediatric patients with inflammatory bowel disease (IBD), namely Crohn´s disease, ulcerative colitis and unclassified colitis, has rapidly increased in Western countries. Areas covered: This review discusses how the treatment of pediatric IBD patients has improved,with attention given to therapeutic quality and cost. The literature search covers Medline-PubMed and the Cochrane Library, with February 2016 as the last search dates. Similarly to what has been the trend in the management of adult IBD, pediatric IBD therapy has become more active than before. High use of immunosuppressants and the availability of biological therapeutic agents has helped to control the extensive and aggressive course of pediatric IBD. Full disease control at an early phase has advantages such as preserving normal child growth and development, maintaining overall good health and quality of life, as well as decreasing the psychosocial burden of the disease. Expert commentary: A key research direction is to tailor treatment modalities according to anticipated individual phenotype and disease course. Another is to reduce healthcare costs by decreasing the so-far high rate of surgery of pediatric IBD patients, and, instead, to develop a more active approach to treatment than before.

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Magnetic resonance enterography guiding treatment in children with Crohn’s jejunoileitis

Abstract: Magnetic resonance enterography identifies disease involvement in the small bowel in young patients with Crohn's disease and may guide decisions on the need for intestinal surgery or adjustment of medication.

Cited by 7 publications

References 23 publications

Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

Impact of Magnetic Resonance Imaging in Management of Pediatric Crohn's Disease

Magnetic resonance colonography with intestine-absorbable nanoparticle contrast agents in evaluation of colorectal inflammation

Progress in the treatment and outcome of pediatric inflammatory bowel disease patients

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