Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?

Zehour AlSabban; Nicholas Carman; Rahim Moineddin; Ryan T Lo; Sebastian K King; Jacob C Langer; Thomas D Walters; Anne M Griffiths; Peter C Church; Mary-Louise C Greer

doi:10.1002/jmri.25888

Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?

J Magn Reson Imaging. 2018 Jun;47(6):1638-1645. doi: 10.1002/jmri.25888. Epub 2017 Nov 14.

Authors

Zehour AlSabban^{1

2}, Nicholas Carman^{3

4}, Rahim Moineddin⁵, Ryan T Lo², Sebastian K King^{6

7}, Jacob C Langer^{6

7}, Thomas D Walters^{3

4}, Anne M Griffiths^{3

4}, Peter C Church^{3

4}, Mary-Louise C Greer^{1

2}

Affiliations

¹ Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.
² Department of Medical Imaging, University of Toronto, Toronto, Canada.
³ Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Canada.
⁴ Department of Pediatrics, University of Toronto, Toronto, Canada.
⁵ Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
⁶ Division of General and Thoracic Surgery, Toronto, Canada.
⁷ The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Canada.

PMID: 29135086
DOI: 10.1002/jmri.25888

Abstract

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) T₂ fast spin-echo (FSE), coronal short tau inversion recovery, axial T₁ FSE, coronal and axial postcontrast FS T₁ FSE; MRE: coronal balanced steady-state free-precession (SSFP), coronal cine SSFP, coronal and axial single-shot T₂ FS, axial SSFP, coronal ultrafast 3D T₁ -weighted gradient echo FS (3D T₁ GE), axial diffusion-weighted imaging, coronal and axial postcontrast 3D T₁ 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.

Keywords: Crohn's disease; MRI; abscess; anal canal; fistula.

MeSH terms

Abscess
Adolescent
Anus Diseases / diagnostic imaging*
Child
Child, Preschool
Colitis, Ulcerative / diagnostic imaging*
Crohn Disease / diagnostic imaging*
Female
Humans
Inflammation
Magnetic Resonance Imaging*
Male
Observer Variation
Pelvis / diagnostic imaging
Radiology
Reproducibility of Results

Supplementary concepts

Pediatric Crohn's disease