Batia Weiss1,2, Dan Turner3, Anne Griffiths4, Tom Walters4, Izabela Herman-Sucharska5, Eva Coppenrath6, Sudha A Anupindi7, Alexander J Towbin8, Kathy O'Brien9, Jared Silverstein10, Victor Navas11, Sibylle Koletzko12, Malgorzata Sladek13, Matan Gavish14, Michal M Amitai2,15. 1. Pediatric Gastroenterology and Nutrition Unit, Edmond and Lily Safra Children's Hospital, Tel-Hashomer. 2. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv. 3. The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel. 4. Division of Gastroenterology, Hospital for Sick Children, Toronto, Ontario, Canada. 5. Electroradiology Department, Faculty of Health Sciences, Collegium Medicum, Jagiellonian University, Krakow, Poland. 6. Department of Radiology, University of Munich, Munich, Germany. 7. Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA. 8. Department of Radiology, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH. 9. Department of Diagnostic Imaging, IWK Health Centre, Halifax, Nova Scotia, Canada. 10. Division of Gastroenterology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA. 11. Pediatric Gastroenterology and Nutrition Unit of Materno Infantil Hospital, Málaga, Spain. 12. Dr. von Hauner Children's Hospital, Clinical Medical Center, LMU, Munich, Germany. 13. Jagiellonian University Medical College, Krakow, Poland. 14. School of Computer Science and Engineering, The Hebrew University, Jerusalem, Israel. 15. Department of Radiology, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Abstract
OBJECTIVES: We aimed to explore the ability of magnetic resonance enterography (MRE) to impute the simple endoscopic score of Crohn disease (SES-CD) in children with CD, in whom failure of ileal intubation is common and may impair SES-CD calculation in clinical studies. METHODS: This is a substudy of the prospective ImageKids study in which children with CD underwent ileocolonoscopy (scored by SES-CD) and MRE (scored on a 100 mm visual analogue scale [VAS] and by MaRIA). Mucosal healing (MH) was defined as SES-CD <3, MRE-VAS <20 mm, and/or MaRIA <7. RESULTS: A total of 237 children (22 centers, age 11.5 ± 3.3 years), were enrolled. Ileal intubation has failed in 40 of 237 (17%). The agreement between SES-CD and MRE was 75% (k = 0.508, P < 0.001) in the ileum, and 68% to 85% in the colonic segments (k = 0.21-0.50, P < 0.001). The sensitivity and specificity of ileal MRE-VAS for MH were 91.7% (95% confidence interval 0.84-0.96) and 53.1% (95% confidence interval 0.43-0.63), respectively. The ileal MaRIA score (calculated in 33/40) was higher in the children without ileal intubation than in the others (20.5 ± 7.1 vs 15.1 ± 10.8, respectively, P = 0.0018). In 7% (16/237) of children, isolated active ileal disease would have been missed when considering SES-CD only. A multivariable model predicted the ileal SES-CD subscore from the MaRIA: SES-CDileum = 1.145 + 0.169 × MaRIAileum rounded to the nearest whole number (R = 0.17). Applying this model to the children without ileal intubation revealed that 29 of 33 (88%) had ileal disease; 8 of 29 patients (28%) with normal colonic SES-CD had imputed ileal SES-CD ≥3. CONCLUSIONS: MRE is useful for imputing the ileal disease in pediatric clinical studies, overcoming the problem of ileal nonintubation.
OBJECTIVES: We aimed to explore the ability of magnetic resonance enterography (MRE) to impute the simple endoscopic score of Crohn disease (SES-CD) in children with CD, in whom failure of ileal intubation is common and may impair SES-CD calculation in clinical studies. METHODS: This is a substudy of the prospective ImageKids study in which children with CD underwent ileocolonoscopy (scored by SES-CD) and MRE (scored on a 100 mm visual analogue scale [VAS] and by MaRIA). Mucosal healing (MH) was defined as SES-CD <3, MRE-VAS <20 mm, and/or MaRIA <7. RESULTS: A total of 237 children (22 centers, age 11.5 ± 3.3 years), were enrolled. Ileal intubation has failed in 40 of 237 (17%). The agreement between SES-CD and MRE was 75% (k = 0.508, P < 0.001) in the ileum, and 68% to 85% in the colonic segments (k = 0.21-0.50, P < 0.001). The sensitivity and specificity of ileal MRE-VAS for MH were 91.7% (95% confidence interval 0.84-0.96) and 53.1% (95% confidence interval 0.43-0.63), respectively. The ileal MaRIA score (calculated in 33/40) was higher in the children without ileal intubation than in the others (20.5 ± 7.1 vs 15.1 ± 10.8, respectively, P = 0.0018). In 7% (16/237) of children, isolated active ileal disease would have been missed when considering SES-CD only. A multivariable model predicted the ileal SES-CD subscore from the MaRIA: SES-CDileum = 1.145 + 0.169 × MaRIAileum rounded to the nearest whole number (R = 0.17). Applying this model to the children without ileal intubation revealed that 29 of 33 (88%) had ileal disease; 8 of 29 patients (28%) with normal colonic SES-CD had imputed ileal SES-CD ≥3. CONCLUSIONS: MRE is useful for imputing the ileal disease in pediatric clinical studies, overcoming the problem of ileal nonintubation.