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- Title
Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?
- Authors
AlSabban, Zehour; Carman, Nicholas; Moineddin, Rahim; Lo, Ryan T.; King, Sebastian K.; Langer, Jacob C.; Walters, Thomas D.; Griffiths, Anne M.; Church, Peter C.; Greer, Mary‐Louise C.; Greer, Mary-Louise C
- Abstract
<bold>Background: </bold>Pediatric Crohn's disease is associated with perianal disease (PAD). Magnetic resonance enterography (MRE) assesses small bowel involvement in pediatric inflammatory bowel disease (PIBD). Pelvic MRI (P-MRI) is the gold standard for assessing PAD.<bold>Purpose: </bold>To determine if MRE can accurately detect PAD in PIBD, distinguishing perianal fistulae (PAF) from perianal abscesses (PAA), referenced against P-MRI.<bold>Study Type: </bold>Retrospective.<bold>Population: </bold>Seventy-seven PIBD patients, 27 females (mean age 14.1 years), with P-MRI and MRE within 6 months.<bold>Field Strength/sequence: </bold>1.5T and 3T; P-MRI: sagittal fat suppressed (FS) T2 fast spin-echo (FSE), coronal short tau inversion recovery, axial T1 FSE, coronal and axial postcontrast FS T1 FSE; MRE: coronal balanced steady-state free-precession (SSFP), coronal cine SSFP, coronal and axial single-shot T2 FS, axial SSFP, coronal ultrafast 3D T1 -weighted gradient echo FS (3D T1 GE), axial diffusion-weighted imaging, coronal and axial postcontrast 3D T1 GE FS.<bold>Assessment: </bold>Two radiologists independently, then by consensus, assessed randomized MRI exams, recording PAF number, location, and length; and PAA number, location, length, and volume. Sensitivity analysis used clinical disease as the gold standard, calculated separately for P-MRI and MRE.<bold>Statistical Tests: </bold>Comparing MRE and P-MRI consensus data, sensitivity, specificity, positive, and negative predictive values (P/NPV) were calculated. Inter- and intrareader reliability were assessed using kappa statistics.<bold>Results: </bold>P-MRI and MRE were paired, detecting PAD in 73 patients, PAF in 63, and PAA in 31 P-MRI. MRE sensitivities, specificities, PPV, and NPV were: PAD 82%, 100%, 100%, 23%; PAF 74%, 71%, 92%, 38%; PAA 51%, 85%, 69%, 72%; clinical 82%, 22%, 37%, 69%; clinical P-MRI 96%, 8%, 37%, 80%. MRE interreader agreement for PAD was moderate (kappa = 0.51 [0.29-0.73]), fair for PAF and PAA.<bold>Data Conclusion: </bold>Using a standard technique, MRE can detect PAD with high specificity and moderate sensitivity in PIBD, missing some PAF and small PAA.<bold>Level Of Evidence: </bold>3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1638-1645.
- Publication
Journal of Magnetic Resonance Imaging, 2018, Vol 47, Issue 6, p1638
- ISSN
1053-1807
- Publication type
journal article
- DOI
10.1002/jmri.25888