title: Detection of Crohn disease lesions of the small and large bowel in pediatric patients: diagnostic value of MR enterography versus reference examinations.
abstract: OBJECTIVE
  The purpose of this article is to prospectively determine the accuracy of MR enterography in detecting Crohn disease lesions from the jejunum to the anorectal region in pediatric patients, in comparison with main reference investigations.
  
  
  METHODS
  Fifty consecutive children with known Crohn disease underwent MR enterography with oral contrast agent and gadolinium-chelate intravenous injection. Two radiologists detected and localized lesions by dividing the bowel into nine segments (450 analyzed segments in 50 patients). Ileocolonoscopy, barium studies, intestinal ultrasound, and capsule endoscopy were considered as first- and second-level reference examinations and were performed within 15 days of MR enterography.
  
  
  RESULTS
  MR enterography detected lesions in 164 of 450 segments, with 155 true-positive and nine false-positive findings; overall sensitivity, specificity, and positive and negative predictive values for small- and large-bowel lesions were 94.5%, 97%, 94.5%, and 97%, respectively (ĸ = 0.93; 95% CI, 0.89-0.97). Sensitivity and specificity values were 88% and 97%, respectively, for the jejunum, 100% and 97% for the proximal-to-mid ileum, 100% and 100% for the distal ileum, 93% and 100% for the cecum, 70% and 97% for the ascending colon, 80% and 100% for the transverse colon, 100% and 92% for the descending colon, 96% and 90% for the sigmoid colon, and 96% and 88% for the rectum. From jejunum to rectum, the AUC value ranged between 0.916 (jejunum) and 1.00 (distal ileum). Perianal fistulas were diagnosed in 15 patients, and other complications were found in 13 patients.
  
  
  CONCLUSIONS
  MR enterography showed an accuracy comparable to that of reference investigations, for both small- and large-bowel lesions. Because MR enterography is safer and more comprehensive than the reference examinations, it should be considered the primary examination for detecting Crohn disease lesions in children.
authors.affiliation: 1 Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome 00161, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Maccioni
authors.forename: Najwa
authors.initials: N
authors.lastname: Al Ansari
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Mazzamurro
authors.forename: Fortunata
authors.initials: F
authors.lastname: Civitelli
authors.forename: Franca
authors.initials: F
authors.lastname: Viola
authors.forename: Salvatore
authors.initials: S
authors.lastname: Cucchiara
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
mesh_terms: D000293:Adolescent; D002648:Child; D003424:Crohn Disease / Q000175:diagnosis*; D016099:Endoscopy, Gastrointestinal / Q000592:standards; D005260:Female; D006801:Humans; D007420:Intestine, Large / Q000473:pathology*; D007421:Intestine, Small / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000592:standards
keywords: MR enterography of Crohn disease; MRI of large bowel Crohn disease; MRI of small bowel Crohn disease; pediatric Crohn disease