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MR enterography in nonresponsive adult celiac disease: Correlation with endoscopic, pathologic, serologic, and genetic features
Author(s) -
Radmard Amir Reza,
Hashemi Taheri Amir Pejman,
Salehian Nik Elham,
Kooraki Soheil,
Kolahdoozan Shadi,
Mirminachi Babak,
Sotoudeh Masoud,
Ekhlasi Golnaz,
Malekzadeh Reza,
Shahbazkhani Bijan
Publication year - 2017
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.25646
Subject(s) - medicine , gastroenterology , serology , confidence interval , receiver operating characteristic , odds ratio , tissue transglutaminase , enteropathy , prospective cohort study , area under the curve , pathology , disease , antibody , immunology , biochemistry , chemistry , enzyme
Purpose To assess small bowel abnormalities on magnetic resonance enterography (MRE) in adult patients with nonresponsive celiac disease (CD) and investigate their associations with endoscopic, histopathologic, serologic, and genetic features. Materials and Methods This prospective study was carried out between September 2012 and August 2013. After approval by the Ethics Committee of our institution, informed consent was acquired from all participants. Forty consecutive patients with nonresponsive CD, aged 17–76 years, underwent MRE using a 1.5T unit. Sequences included T 2 ‐HASTE, True‐FISP, pre‐ and postcontrast VIBE to assess the quantitative (number of ileal and jejunal folds) and qualitative (fold pattern abnormalities, mural thickening, increased enhancement, bowel dilatation, or intussusception) measures. Endoscopic manifestations were categorized as normal/mild vs. severe. Histopathological results were divided into mild and severe. Genotyping of HLA‐DQ2 and DQ8 was performed. Serum levels of tissue‐transglutaminase, endomysial, and gliadin antibodies were also determined. Logistic regression analysis and receiver operating characteristic (ROC) curve were used. Results Twenty‐nine (72.5%) cases showed abnormal MRE. Reversed jejunoileal fold pattern had significant association with severe endoscopic (odds ratio [OR] = 8.38, 95% confidence interval [CI] 1.73–40.5) and pathologic features (OR = 7.36, 95% CI 1.33–40.54). An increased number of ileal folds/inch was significantly associated with severe MARSH score and positive HLA‐DQ8. ( P < 0.001 and P = 0.026, respectively). Ileal fold number had the highest areas under the curve for prediction of severe endoscopic (AUC: 0.75, P = 0.009) and pathologic (AUC: 0.84, P < 0.001) findings and positive anti‐transglutaminase antibody (AUC: 0.85, P = 0.027). Conclusion Fold pattern reversal on MRE is highly associated with endoscopic and pathologic features of refractory celiac disease (RCD). Increased ileal folds showed higher correlation with endoscopic‐pathologic features, HLA‐DQ8, and anti‐transglutaminase level. MRE might be more sensitive for detection of increased ileal folds in CD rather than reduction of duodenal and jejunal folds due to better distension of ileal loops. Level of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1096–1106.