title: Feasibility of using MR enterography for the assessment of terminal ileitis and inflammatory activity in children with Crohn disease.
abstract: OBJECTIVE
  Radiation exposure increases cancer risk in children with Crohn disease (CD). Magnetic resonance enterography (MRE) can image the gastrointestinal tract without exposure to radiation. The aim of the present study was to determine whether our MRE protocol could diagnose terminal ileitis and the degree of inflammatory activity in children with CD.
  
  
  METHODS
  Retrospective review of patients 18 years of age or younger who underwent MRE for known or suspected CD from June 15, 2007 to April 1, 2010. MRE was performed with Volumen and water as oral contrast and gadolinium-based intravenous contrast. No antiperistaltic agent was used. Each MRE was compared with ileal biopsies obtained within 90 days. Severity of inflammation on MRE was scored and compared with the Pediatric Crohn Disease Activity Index (PCDAI).
  
  
  RESULTS
  Seventy-two patients underwent 80 MREs during the study period. Forty-two of the 72 patients (58.3%) underwent colonoscopy within 90 days of MRE, and the terminal ileum was intubated in 33. Compared with histology, MRE had a sensitivity of 71.4% and a specificity of 100% for terminal ileitis. The positive and negative predictive values were 100% and 70%, respectively. PCDAI was calculated in 39 of the 72 patients (54.2%) and had a statistically significant positive correlation with MRE score of 0.37 (P = 0.020426).
  
  
  CONCLUSIONS
  In children with known or suspected CD, our MRE protocol has a high specificity and positive predictive value for terminal ileitis. Severity of inflammation on MRE had a statistically significant positive correlation with PCDAI.
authors.affiliation: Division of Pediatric Gastroenterology, Nutrition, and Liver Disease, Warren Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI 02903, USA. jsilverstein4@gmail.com
authors.forename: Jared
authors.initials: J
authors.lastname: Silverstein
authors.forename: David
authors.initials: D
authors.lastname: Grand
authors.forename: David
authors.initials: D
authors.lastname: Kawatu
authors.forename: Samir A
authors.initials: SA
authors.lastname: Shah
authors.forename: Jill
authors.initials: J
authors.lastname: Steinkeler
authors.forename: Neal
authors.initials: N
authors.lastname: LeLeiko
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D003113:Colonoscopy; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005682:Gadolinium; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging* / Q000473:pathology; D007082:Ileum / Q000000981:diagnostic imaging* / Q000473:pathology; D007249:Inflammation / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014867:Water
chemical_list: D014867:Water; D005682:Gadolinium