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Intestinal lesions in pediatric Crohn disease: comparative detectability among pulse sequences at MR enterography

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Abstract

Background

Variable sequences can be used in MR enterography, and no consensus exists for the best protocol in children with Crohn disease.

Objective

To compare the lesion detectability of various MR enterography sequences and to correlate the findings of these sequences with the Pediatric Crohn’s Disease Activity Index (PCDAI) in children with Crohn disease.

Materials and methods

Children with clinically or pathologically confirmed Crohn disease underwent MR enterography, including a single-shot fast spin-echo (SSFSE) sequence, motility imaging (coronal 2-D balanced fast field echo), diffusion-weighted imaging (DWI), and dynamic contrast enhancement imaging (including arterial, portal and delayed phases). The lesion detectability of each sequence was graded 0–2 for each involved bowel segment. The lesion detectability and PCDAI result on different sequences were compared using the weighted least squares method and Student’s t-test, respectively.

Results

Fifteen children (11 boys, 4 girls, mean age 13.7 ± 1.4 years) with a total of 41 lesions were included in this study. All lesions detected in more than two sequences were visible on the single-shot fast spin-echo (SSFSE) sequence. The relative lesion detection rate was 78.1% on motility imaging, 90.2% on DWI, and 92.7% on arterial, 95.1% on portal and 95.1% on delayed phase imaging. Compared to the SSFSE sequence, motility imaging (P < 0.001) and DWI (P = 0.039) demonstrated lower detectability. The mean PCDAI result in the detected lesions was statistically higher only on dynamic enhancement imaging (P < 0.001).

Conclusion

All MR enterography sequences were found to have relatively high lesion detectability in children with Crohn disease, while motility imaging showed the lowest lesion detectability. Lesions detected on dynamic enhancement imaging showed a higher PCDAI result, which suggests that this sequence is specific for active inflammation.

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiological Science, Severance Children’s Hospital, Yonsei University, College of Medicine, 50 Yonsei-ro, Seodaemun-gu, 120-752, Seoul, South Korea

    Beomseok Sohn, Myung-Joon Kim & Mi-Jung Lee

  2. Department of Pediatrics, Severance Children’s Hospital, Seoul, South Korea

    Hong Koh

  3. Biostatistics Collaboration Unit, Yonsei University, College of Medicine, Seoul, South Korea

    Kyung Hwa Han

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  1. Beomseok Sohn
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  2. Myung-Joon Kim
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  3. Hong Koh
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  4. Kyung Hwa Han
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Correspondence to Mi-Jung Lee.

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Sohn, B., Kim, MJ., Koh, H. et al. Intestinal lesions in pediatric Crohn disease: comparative detectability among pulse sequences at MR enterography. Pediatr Radiol 44, 821–830 (2014). https://doi.org/10.1007/s00247-014-2902-7

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  • DOI: https://doi.org/10.1007/s00247-014-2902-7

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