Simple Endoscopic Score of Crohn Disease and Magnetic Resonance Enterography in Children: Report From ImageKids Study

Weiss, Batia; Turner, Dan; Griffiths, Anne; Walters, Tom; Herman-Sucharska, Izabela; Coppenrath, Eva; Anupindi, Sudha A.; Towbin, Alexander J.; O'Brien, Kathy; Silverstein, Jared; Navas, Victor; Koletzko, Sibylle; Sladek, Malgorzata; Gavish, Matan and Amitai, Michal M. (2019): Simple Endoscopic Score of Crohn Disease and Magnetic Resonance Enterography in Children: Report From ImageKids Study. In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 69, No. 4: pp. 461-465

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 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 x MaRIA(ileum) rounded to the nearest whole number (R-2 = 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.

• Item Type: Journal article
• Faculties: Medicine
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 0277-2116
• Language: English