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

2013 ◽  
Vol 79 (7) ◽  
pp. 672-675 ◽  
Author(s):  
Cristen Litz ◽  
Paul D. Danielson ◽  
Michael Wilsey ◽  
Nicole M. Chandler
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Crohn's Disease ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Clinical History ◽  
Radiographic Evaluation ◽  
The Impact ◽  
Active Disease ◽  
New Onset

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.

scholarly journals Video capsule endoscopy in pediatric patients with Crohn’s disease: a single-center experience of 180 procedures

2018 ◽  
Vol 11 ◽  
pp. 175628481875892 ◽  
Author(s):  
Artur Nemeth ◽  
Daniel Agardh ◽  
Gabriele Wurm Johansson ◽  
Henrik Thorlacius ◽  
Ervin Toth
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Pediatric Patients ◽  
Video Capsule Endoscopy ◽  
Single Center ◽  
Recording Time ◽  
Single Center Experience ◽  
Capsule Retention ◽  
The Impact

Background Video capsule endoscopy (VCE) is a noninvasive method enabling excellent visualization of the small bowel (SB) mucosa. The aim of this study was to examine the impact and safety of VCE performed in children and adolescents with suspected or established Crohn’s disease (CD). Methods A total of 180 VCE examinations in 169 consecutive patients conducted in 2003–14 in a single center were retrospectively analyzed. The median age was 13 years (range 3–17 years) and indications for VCE were suspected (125 cases, 69%) and established (55 cases, 31%) CD. VCE was performed with a PillCam SB (Given Imaging, Yokneam, Israel) VCE system with 8–12 h of registration without bowel preparation. Results A total of 154 of 180 (86%) patients swallowed the capsule and 26 (14%) had the capsule endoscopically placed in the duodenum. Patency capsule examination was performed in 71 cases prior to VCE to exclude SB obstruction. VCE detected findings consistent with SB CD in 71 (40%) examinations and 17 (9%) procedures showed minor changes not diagnostic for CD. A total of 92 (51%) examinations displayed normal SB mucosa. The capsule did not reach the colon within the recording time in 30 (17%) procedures and were defined as incomplete examinations. A change in diagnosis or therapy was recommended in 56 (31%) patients based on VCE results. Capsule retention occurred in one patient. Conclusions VCE is a safe method in children with suspected or established CD. VCE often leads to a definitive diagnosis and has a significant impact on the clinical management of pediatric patients with CD.

A review of Magnetic Resonance Enterography classification and quantitative evaluation of active disease in patients with Crohn's disease

2021 ◽  
Vol 69 ◽  
pp. 50-62
Author(s):  
Laura Maria Minordi ◽  
Luigi Larosa ◽  
Alfredo Papa ◽  
Giovanni Cimino ◽  
Antonio Bevere ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Crohn's Disease ◽  
Quantitative Evaluation ◽  
Magnetic Resonance Enterography ◽  
Active Disease

scholarly journals DOP15 Transmural healing with vedolizumab in patients with active Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S053-S056
Author(s):  
J Rimola ◽  
J F Colombel ◽  
B Bressler ◽  
S Adsul ◽  
J Siegelman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Magnetic Resonance ◽  
Crohn's Disease ◽  
Wall Thickness ◽  
Activity Index ◽  
Exploratory Analysis ◽  
Imaging Features ◽  
Number Of Patients ◽  
Transmural Inflammation ◽  
The Impact

Abstract Background VERSIFY, an open-label phase 3b study of vedolizumab (NCT02425111; EudraCT 2014-003509-13), demonstrated endoscopic mucosal healing in patients with Crohn’s disease (CD).1 An exploratory analysis of a subset of these patients who underwent magnetic resonance enterography (MREn) also demonstrated healing.1 Further exploratory analysis of MREn imaging features of transmurality in patients treated with vedolizumab is reported herein. Methods In VERSIFY, patients treated with intravenous vedolizumab (300 mg) on Day 1, Weeks 2 and 6, and then every 8 weeks for 26 or 52 weeks were imaged at screening, Week 26, and Week 52, with images assessed centrally.1 All patients with disease detectable by MREn at screening (≥1 ileocolonic segment with a segmental magnetic resonance index of activity [MaRIA] score ≥7) who completed 26 or 52 weeks of treatment and had evaluable segments at all MREn timepoints were included in this analysis. Ileocolonic segments with a MaRIA score ≥7 at baseline were evaluated for improvement of oedema and bowel wall thickness. Further exploratory assessment of mesenteric fluid and lymph nodes are ongoing. Results Week 26 analyses included 27 patients with a total of 83 ileocolonic segments; Week 52 analyses included 13 patients with a total of 38 segments. Week 26 and Week 52 patient populations had baseline mean (standard deviation [SD]) simplified endoscopic activity scores for CD (SES-CD) of 15.7 (7.7) and 16.5 (7.8) and Crohn’s disease activity index (CDAI) scores of 301 (61) and 297 (79), respectively. The proportion of segments with oedema or wall thickness >3 mm decreased from baseline to Week 26 and to Week 52 (Figure 1). All segments evaluated had wall thickness >3 mm at baseline. The proportion of patients with oedema or wall thickness >3 mm in ≥1 evaluated segment decreased from baseline to Week 26 and/or Week 52 (Figure 2). In the Week 26 population, 2/27 (7.4%) patients had no oedema with wall thickness <3 mm at Week 26 in segments that had MaRIA ≥7 at baseline. In the Week 52 population, 1/13 (7.7%) patients at Week 26 and 3/13 (23.1%) at Week 52 had no oedema with wall thickness <3 mm in segments that had MaRIA ≥7 at baseline. Conclusion Vedolizumab treatment of patients with CD reduced the number of ileocolonic segments with transmural inflammation (oedema, wall thickness >3 mm) as detected by MREn and the overall number of patients with transmural inflammation from baseline at treatment Weeks 26 and 52. This exploratory analysis contributes to the understanding of transmural disease processes in CD and the impact of vedolizumab on components of transmural inflammation in CD. Reference

scholarly journals ROLE OF MAGNETIC RESONANCE ENTEROGRAPHY IN THE DIAGNOSTICS OF ACTIVE CROHN’S DISEASE IN CHILDREN

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S11-S11
Author(s):  
Karolina Siejka ◽  
Maryla Kuczynska ◽  
Magdalena Grzegorczyk ◽  
Malgorzata Nowakowska ◽  
Monika Piekarska ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Magnetic Resonance ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Pediatric Patients ◽  
Ileocecal Valve ◽  
Magnetic Resonance Enterography ◽  
Mr Enterography ◽  
Local Study

Abstract Background Crohn’s disease (CD) is an idiopathic inflammatory bowel disease of the gastrointestinal tract. It is more common in the developed and industrialized countries, particularly in the Western Europe and North America. Up to 20–30% of patients present first symptoms during childhood or adolescence. Traditionally it is diagnosed by clinical indicates, endoscopy and histological findings. Assessment of the disease activity and location along the gastrointestinal tract are of crucial importance for diagnosis and implementation of the proper treatment. Active inflammation can manifest as mural thickening, edema, ulcerations, abscesses or fistulas. Magnetic resonance enterography (MRE) is the most modern radiological method in depicting all of these manifestations of CD. Objective The aim of the study was to assess the value of MRE in evaluation of Crohn’s disease in pediatric patients. Materials and Methods 18 children (8 boys, 10 girls) with confirmed diagnosis of Crohn’s disease, were included in the study. Each patient underwent MR enterography with intravenous administration of a contrast agent. All studies were performed using a 1.5T scanner according to a local study protocol. Results All MRE findings were associated with small bowel inflammation. All patients showed asymmetric ileal wall thickening and edema. Edematous ileocecal valve was visible in 8 patients. In 7 cases reactive lymphadenopathy was detected (lymph nodes ≥ 10 mm in short axis). In 4 patients small intestine fistulas were found, whereas abscess was observed in another 4 patients. In contrast-enhanced images, a vivid enhancement of the affected bowel section was revealed in all patients and in 10 children inflammatory infiltration of periintestinal fat was depicted. Conclusion MRE is a reliable tool in diagnosis, evaluation of the disease activity and assessment of potential complications of Crohn’s disease. Due to the lack of ionizing radiation MRE exhibits beneficial safety profile and can be offered to patients who repeatedly require follow-up examinations, especially in pediatric patients.

scholarly journals Surgery-Related Quality of Life of Pediatric Patients With Crohn's Disease

2020 ◽  
Vol 8 ◽  
Author(s):  
Valeria Dipasquale ◽  
Enrica Antonelli ◽  
Laura Cannavò ◽  
Giorgio Cavatoi ◽  
Carmelo Romeo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Pediatric Patients ◽  
University Hospital ◽  
Ileocecal Resection ◽  
Severe Problem ◽  
Related Quality ◽  
The Impact

Objective: Up to 30% of pediatric patients with Crohn's disease (CD) require surgery. The aim of the study was to evaluate long-term health-related quality of life (HRQoL) outcome in children with CD who have had ileocolonic resection.Materials and methods: This was a retrospective cross-sectional study on all pediatric patients who had undergone surgery for CD between January 2015 and December 2017 in the Pediatric Surgery and Gastroenterology Units of the University Hospital of Messina. Surgical treatment was represented by laparoscopic ileocecal resection with latero-lateral anastomosis. Patients were asked to fill in a modified version of the IMPACT III questionnaire made up of 15 closed questions before and after surgery. The questionnaire was scored on a five-point scale with 5 reporting “not a problem” and 1 “a very severe problem.” The total score ranged from 15 (worst HRQoL) to 75 (best HRQoL). Frequency of relapses, reoperations, complications during follow-up, and postoperative bowel function were also studied.Results: Data were obtained in 10 patients (9 males), who underwent surgery at a median age of 13.5 years (range 13–18), after a median post-diagnosis period of 2.5 years (range 0–8). Preoperative scores were low in all 4 domains of the questionnaire. Postoperatively, HRQoL measures improved significantly (p < 0.05) about symptoms, school attendance, social and emotional functioning. Overall, nearly all patients were completely satisfied with the surgical outcome.Conclusions: HRQoL is low in CD children referred for possible operation, and surgery may positively affect the overall HRQoL. Collecting HRQoL data provides insight into the impact of treatment on children health status.

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