Manifestations of small bowel disease in pediatric Crohnʼs disease on magnetic resonance enterography

Torkzad, Michael R.; Ullberg, Ulla; Nyström, Niklas; Blomqvist, Lennart; Hellström, Per M.; Fagerberg, Ulrika L.

doi:10.1002/ibd.21725

Cited by 9 publications

(9 citation statements)

References 40 publications

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“…This survey illustrates a degree of discrepancy among experts performing MRE. Considering the proportion agreeing on a valid indication for MRE, only two indications exceeded 80 %: the initial diagnosis and follow-up of Crohn’s disease [ 6 – 18 ]. Otherwise, we observed a wide variation among our experts regarding other indications for MRE.…”

Section: Discussionmentioning

confidence: 99%

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey

et al. 2015

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AimsTo survey the perceived indications for magnetic resonance imaging of the small bowel (MRE) by experts, when MR enteroclysis (MREc) or MR enterography (MREg) may be chosen, and to determine how the approach to MRE is modified when general anaesthesia (GA) is required.Materials and methodsSelected opinion leaders in MRE completed a questionnaire that included clinical indications (MREg or MREc), specifics regarding administration of enteral contrast, and how the technique is altered to accommodate GA.ResultsFourteen responded. Only the diagnosis and follow-up of Crohn’s disease were considered by over 80 % as a valid MRE indication. The remaining indications ranged between 35.7 % for diagnosis of caeliac disease and unknown sources of gastrointestinal bleeding to 78.6 % for motility disorders. The majority chose MREg over MREc for all indications (from 100 % for follow-up of caeliac disease to 57.7 % for tumour diagnosis). Fifty per cent of responders had needed to consider MRE under GA. The most commonly recommended procedural change was MRI without enteral distention. Three had experience with intubation under GA (MREc modification).ConclusionViews were variable. Requests for MRE under GA are not uncommon. Presently most opinion leaders suggest standard abdominal MRI when GA is required.Main messages• Experts are using MRE for various indications.• Requests for MRE under general anaesthesia are not uncommon.• Some radiologists employ MREc under general anaesthesia; others do not distend the small bowel.

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Section: Discussionmentioning

confidence: 99%

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey

et al. 2015

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“…Although the exact frequency of the small bowel (SB) CD is unknown, most gastroenterologists believe that its prevalence has been underestimated and that it may have an increased incidence among children and young adolescents [2] . A recent study performed in pediatric patients with magnetic resonance (MR) enterography [3] , according to previous studies [4] , confirmed that the involvement of the terminal ileum is common to more than three times compared to that of the jejunum and the rest of the ileum. Moreover, the involvement of the jejunum alone is uncommon and it is more difficult to investigate because of its tendency to stay non distended [3] .…”

Section: Introductionmentioning

confidence: 78%

“…A recent study performed in pediatric patients with magnetic resonance (MR) enterography [3] , according to previous studies [4] , confirmed that the involvement of the terminal ileum is common to more than three times compared to that of the jejunum and the rest of the ileum. Moreover, the involvement of the jejunum alone is uncommon and it is more difficult to investigate because of its tendency to stay non distended [3] . The clinical importance of the SB CD phenotype is the impact that a diffuse SB disease is expected to have on a child's growth and development.…”

Section: Introductionmentioning

confidence: 78%

Imaging of the small bowel: Crohn’s disease in paediatric patients

Casciani

Vincentiis

Polettini

et al. 2014

WJR

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In more than 20% of all patients, the Crohn's disease presents before the age of 18 years. The diagnosis and management of Crohn's disease in children has changed dramatically over the last decade, mainly due to increased awareness, availability of newer diagnostic modalities such as magnetic resonance imaging (MRI) and newer, more powerful treatments such as biologics. Imaging of the small bowel is needed for diagnosis, management, follow-up and also evaluation of the disease in terms of location, extent, activity and complications. We review all the methods (barium examinations, ultrasonography, computed tomography, MR, and computed tomography-positron emission tomography) commonly used for imaging the small bowel in paediatric patients with Crohn's disease analyzing the advantages and disadvantages of each modality, with particular emphasis on MR imaging.

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“…Bowel wall thickening is the common finding of CD with sensitivity of 83%-91% and a specificity of 86%-100% at MR enterography [50] . It is defined as a bowel wall thickness measuring more than 3 mm in a distended loop and may be eccentric or concentric and smooth or nodular and several study [5,43] . Masselli et al [42] confirmed that the terminal ileum is the most common localiazation of bowel wall thickness ( Figure 2).…”

Section: Indicationsmentioning

confidence: 99%

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

Masselli

Mastroiacovo

Marco

et al. 2016

WJR

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Crohn's disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.

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Manifestations of small bowel disease in pediatric Crohnʼs disease on magnetic resonance enterography

Abstract: MRE in the pediatric population often demonstrates increased contrast uptake, bowel wall thickening, and perienteral lymphadenopathy in CD. More chronic small bowel changes seen commonly in adults and solitary jejunal involvements are less commonly seen.

Cited by 9 publications

References 40 publications

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey

Indications and selection of MR enterography vs. MR enteroclysis with emphasis on patients who need small bowel MRI and general anaesthesia: results of a survey

Imaging of the small bowel: Crohn’s disease in paediatric patients

Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease

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