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Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?
Author(s) -
AlSabban Zehour,
Carman Nicholas,
Moineddin Rahim,
Lo Ryan T.,
King Sebastian K.,
Langer Jacob C.,
Walters Thomas D.,
Griffiths Anne M.,
Church Peter C.,
Greer MaryLouise C.
Publication year - 2018
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.25888
Subject(s) - coronal plane , medicine , magnetic resonance imaging , sagittal plane , nuclear medicine , gold standard (test) , steady state free precession imaging , radiology , inflammatory bowel disease , kappa , population , pathology , disease , mathematics , geometry , environmental health
Background Pediatric Crohn's disease is associated with perianal disease (PAD). Magnetic resonance enterography (MRE) assesses small bowel involvement in pediatric inflammatory bowel disease (PIBD). Pelvic MRI (P‐MRI) is the gold standard for assessing PAD. Purpose To determine if MRE can accurately detect PAD in PIBD, distinguishing perianal fistulae (PAF) from perianal abscesses (PAA), referenced against P‐MRI. Study Type Retrospective. Population Seventy‐seven PIBD patients, 27 females (mean age 14.1 years), with P‐MRI and MRE within 6 months. Field Strength/Sequence 1.5T and 3T; P‐MRI: sagittal fat suppressed (FS) T 2 fast spin‐echo (FSE), coronal short tau inversion recovery, axial T 1 FSE, coronal and axial postcontrast FS T 1 FSE; MRE: coronal balanced steady‐state free‐precession (SSFP), coronal cine SSFP, coronal and axial single‐shot T 2 FS, axial SSFP, coronal ultrafast 3D T 1 ‐weighted gradient echo FS (3D T 1 GE), axial diffusion‐weighted imaging, coronal and axial postcontrast 3D T 1 GE FS. Assessment Two radiologists independently, then by consensus, assessed randomized MRI exams, recording PAF number, location, and length; and PAA number, location, length, and volume. Sensitivity analysis used clinical disease as the gold standard, calculated separately for P‐MRI and MRE. Statistical Tests Comparing MRE and P‐MRI consensus data, sensitivity, specificity, positive, and negative predictive values (P/NPV) were calculated. Inter‐ and intrareader reliability were assessed using kappa statistics. Results P‐MRI and MRE were paired, detecting PAD in 73 patients, PAF in 63, and PAA in 31 P‐MRI. MRE sensitivities, specificities, PPV, and NPV were: PAD 82%, 100%, 100%, 23%; PAF 74%, 71%, 92%, 38%; PAA 51%, 85%, 69%, 72%; clinical 82%, 22%, 37%, 69%; clinical P‐MRI 96%, 8%, 37%, 80%. MRE interreader agreement for PAD was moderate (kappa = 0.51 [0.29–0.73]), fair for PAF and PAA. Data Conclusion Using a standard technique, MRE can detect PAD with high specificity and moderate sensitivity in PIBD, missing some PAF and small PAA. Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1638–1645.