Improving MRE Utility in Pediatric Crohn’s

G Focht et al. Gastroenterol 2022; 163: 1306-1320. Open Access! Development, Validation, and Evaluation of the Pediatric Inflammatory Crohn’s Magnetic Resonance Enterography Index From the ImageKids Study

In this prospective study of children (n-240) with Crohn’s disease, the authors utilized ileocolonoscopy and MREs (n=159) and followed for 18 months.

Key findings:

  • 5 MRE findings were identified to generate a PICMI (Pediatric Inflammatory Crohn’s Magnetic Resonance Enterography Index): wall thickness, wall diffusion weighted imaging, ulcerations, mesenteric edema, and comb sign
  • In the validation cohort of 81 MREs, the weighted global PICMI correlated well with the radiologist global assessment (r = 0.85; P < .001) and with the simple endoscopic score in a subsample with ileocolonic disease (r = 0.63; P < .001).
  •  Interobserver and test-retest reliability were high (interclass correlation coefficients, 0.84 and 0.81, respectively; both P < .001)
  • Transmural healing was defined as PICMI ≤10 and response as a change of >20 points with excellent discriminative validity (area under the receiver operating characteristic curve = 0.96

My take: This study identifies a specific MRI index (PICMI) that is reliable for assessing the entire bowel in pediatric CD and does not require intravenous gadolinium or rectal enema. By using a standardized tool, similar to SEMA-CD for ileocolonoscopy, this will improve the usefulness of MREs.

Also noted: Link: Clinical support tool (sponsored by AGA) that provides individualized information on 2nd line therapy effectiveness (ustekinumab and vedolizumab) with regard to probability of achieving clinical remission, how quick to expect a response, and whether therapeutic drug monitoring is needed.

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