Stacy J Kim1, Thomas L Ratchford2, Paula M Buchanan3, Dhiren R Patel2, Ting Y Tao4, Jeffrey H Teckman2, Jeffrey J Brown1, Shannon G Farmakis5. 1. Department of Radiology, SSM Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Ave. at Grand Boulevard, St. Louis, MO, 63110, USA. 2. Department of Gastroenterology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA. 3. Center of Health Outcomes Research, Saint Louis University, 3545 Lafayette Ave., St. Louis, MO, 63104, USA. 4. Department of Radiology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA. 5. Department of Radiology, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, 1465 S. Grand Blvd., St. Louis, MO, 63104, USA. shannon.farmakis@health.slu.edu.
Abstract
BACKGROUND: Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of gadolinium deposition given the potential need for multiple contrast-enhanced magnetic resonance enterography (MRE) exams over their lifetime. OBJECTIVE: To determine whether gadolinium-based contrast agents are necessary in assessing active bowel inflammation on MRE in pediatric patients with known or suspected IBD. MATERIALS AND METHODS: We conducted a retrospective study of 77 patients (7-18 years; 68.8% male) with known (n=58) or suspected (n=19) IBD and endoscopy with biopsy performed within 30 days of MRE without and with contrast evaluated bowel and non-bowel findings. During three visual analysis sessions, two radiologists reviewed pre-, post-, and pre-/post-contrast MRE images. A third radiologist independently reviewed 27 studies to assess inter-reader reliability. We used Cohen kappa (κ), Fleiss kappa, (κF), McNemar test, and sensitivity and specificity to compare MRE readings to combined endoscopic/histopathological findings (the reference standard). RESULTS: The pre- and pre-/post-contrast-enhanced MRE vs. combined endoscopic/histopathological results had moderate agreement (85.7%; κ 0.713, P<0.001; P-value 0.549). Compared to combined endoscopy/histopathology, pre- vs. pre-/post-contrast sensitivity (67%, confidence interval [CI] 0.53-0.79 vs. 67%, CI 0.53-0.79) and specificity (80%, CI 0.59-0.92 vs. 68%, CI 0.46-0.84) varied little (κ 0.42, P<0.001 and κ 0.32, P=0.003, respectively). The three readers had moderate agreement (85.2%; κ 0.695, P=0.001; P-value 0.625). More penetrating complications were identified following contrast administration (P-value 0.04). CONCLUSION: Use of a contrast agent does not improve the detection of active inflammation in the terminal ileum and colon compared to non-contrast MRE, although use of a contrast agent does aid in the detection of penetrating disease.
BACKGROUND: Pediatric patients with inflammatory bowel disease (IBD) are at increased risk of gadolinium deposition given the potential need for multiple contrast-enhanced magnetic resonance enterography (MRE) exams over their lifetime. OBJECTIVE: To determine whether gadolinium-based contrast agents are necessary in assessing active bowel inflammation on MRE in pediatric patients with known or suspected IBD. MATERIALS AND METHODS: We conducted a retrospective study of 77 patients (7-18 years; 68.8% male) with known (n=58) or suspected (n=19) IBD and endoscopy with biopsy performed within 30 days of MRE without and with contrast evaluated bowel and non-bowel findings. During three visual analysis sessions, two radiologists reviewed pre-, post-, and pre-/post-contrast MRE images. A third radiologist independently reviewed 27 studies to assess inter-reader reliability. We used Cohen kappa (κ), Fleiss kappa, (κF), McNemar test, and sensitivity and specificity to compare MRE readings to combined endoscopic/histopathological findings (the reference standard). RESULTS: The pre- and pre-/post-contrast-enhanced MRE vs. combined endoscopic/histopathological results had moderate agreement (85.7%; κ 0.713, P<0.001; P-value 0.549). Compared to combined endoscopy/histopathology, pre- vs. pre-/post-contrast sensitivity (67%, confidence interval [CI] 0.53-0.79 vs. 67%, CI 0.53-0.79) and specificity (80%, CI 0.59-0.92 vs. 68%, CI 0.46-0.84) varied little (κ 0.42, P<0.001 and κ 0.32, P=0.003, respectively). The three readers had moderate agreement (85.2%; κ 0.695, P=0.001; P-value 0.625). More penetrating complications were identified following contrast administration (P-value 0.04). CONCLUSION: Use of a contrast agent does not improve the detection of active inflammation in the terminal ileum and colon compared to non-contrast MRE, although use of a contrast agent does aid in the detection of penetrating disease.
Authors: Alexander Radbruch; Lukas D Weberling; Pascal J Kieslich; Oliver Eidel; Sina Burth; Philipp Kickingereder; Sabine Heiland; Wolfgang Wick; Heinz-Peter Schlemmer; Martin Bendszus Journal: Radiology Date: 2015-04-06 Impact factor: 11.105
Authors: Pietro Valerio Foti; Renato Farina; Maria Coronella; Stefano Palmucci; Noemi Ognibene; Pietro Milone; Cristina Conti Bellocchi; Leonardo Samperi; Gaetano Inserra; Andrea Laghi; Giovanni Carlo Ettorre Journal: Radiol Med Date: 2015-02-04 Impact factor: 3.469