Jim Kling

May 01, 2012

May 1, 2012 (Vancouver, British Columbia) — Magnetic resonance enterography (MR-E) is comparable to computed tomographic enterography (CT-E) in the detection of inflammation and fibrotic tissue in children with Crohn's disease, according to research presented here at the American Roentgen Ray Society 2012 Annual Meeting.

The results were presented by Keith Quencer, MD, a radiology resident at Massachusetts General Hospital in Boston.

The diagnosis of inflammation and fibrosis is important in the management of children with Crohn's disease because inflammation calls for medication and fibrosis requires surgical intervention.

CT-E has traditionally been used for such evaluations, but the exposure of children to ionizing radiation is of increasing concern, particularly among patients with Crohn's disease who can be subject to frequent imaging. That concern has prompted interest in the use of MR-E. Previous research has shown that MR-E is equivalent to or better than CT-E in the detection of fistula, abscesses, and perianal complications of Crohn's disease, according to Jeanne Chow, MD, assistant professor of radiology at Harvard Medical School and Children's Hospital in Boston, who moderated the session.

To assess the accuracy of MR-E and CT-E in detecting features of Crohn's disease (lymphadenopathy, bowel wall thickening, mesenteric inflammation, abscess formation) in children, the researchers conducted a single-institution prospective study of 23 patients with Crohn's disease. The patients were scheduled to undergo CT-E for various symptoms, including abdominal pain, changes in bowel habits, fever, and leukocytosis; they underwent MR-E at the same visit.

Two independent pediatric radiologists reviewed the CT-E and MR-E findings, using CT-E as the reference standard. For patients who underwent surgical bowel resection within 7 weeks of imaging (for inflammation and fibrosis), MR-E and CT-E results were compared to a full thickness histologic reference of 61 bowel segments.

The researchers found that the accuracy of the detection of inflammation was 83.6% for MR-E and 81.9% for CT-E (P = .5). MR-E outperformed CT-E in the detection of fibrosis (accuracy, 80.8% vs 55.6%), but the results were not statistically significant (P = .058).

The results suggest that MR-E should play a primary role in the imaging of children with Crohn's disease, according to the researchers. The technique is not likely to find universal application, however, because of its higher cost and the fact that CT is more generally available. It is also unlikely to find use in emergency applications because sick patients might not be able to drink large quantities of contrast fluid and because it is slower. "You can zip through a CT in 20 seconds," Dr. Quencer told Medscape Medical News.

Other limitations could restrict the use of MR-E. "It also takes more expertise to read an MR than a CT," Dr. Quencer added.

Despite these issues, MR-E is becoming more popular. "I think this [study] confirms the accuracy of MR-E, compared with CT-E, and how MR-E in many ways is more useful. This is the trend — people are doing more MR-E than CT-E," Dr. Chow told Medscape Medical News.

Dr. Quencer and Dr. Chow have disclosed no relevant financial relationships.

American Roentgen Ray Society (ARRS) 2012 Annual Meeting: Abstract 14. Presented April 30, 2012.

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