Matthew Paul Moy MD, Presenter: Nothing to Disclose

Jess Kaplan MD, Abstract Co-Author: Nothing to Disclose

Christopher James Moran MD, Abstract Co-Author: Nothing to Disclose

Harland Steven Winter MD, Abstract Co-Author: Consultant, PAREXEL International Corporation Consultant, Johnson & Johnson Consultant, Shire plc Consultant, Salix Pharmaceuticals, Inc Institutional Grant support, Johnson & Johnson Institutional Grant support, AstraZeneca PLC Institutional Grant support, Shire plc

Michael Stanley Gee MD, PhD, Abstract Co-Author: Nothing to Disclose

We evaluated qualitative and quantitative magnetic resonance enterography (MRE) findings which best correlate with mucosal healing assessed by ileocolonoscopy as a reference standard.

In this IRB-approved, HIPAA-compliant retrospective study, patients 18 years of age or below with Crohn’s disease were identified who underwent two ileocolonoscopy exams to assess disease activity with an MRE closely timed with the second endoscopy. Two pediatric gastroenterologists reviewed the paired endocopic exams by consensus to assess inflammatory activity as reference. All bowel segments with macroscopic evidence of inflammation on the first endoscopy were included in the study, and were then categorized for the presence or absence of mucosal healing (MH) based on whether macroscopic inflammation was observed on the second endoscopy. An experienced pediatric abdominal radiologist evaluated the corresponding MRE exams of these patients, blinded to the endoscopic results, for multiple imaging features associated with active inflammation. Imaging-endoscopic correlation was then performed.

25 patients were included in the study (mean age 17.6 + 2.8 years) with a mean time between MRE and endoscopy of 12.4 + 7.3 days. On endoscopy, 38 bowel segments demonstrated MH and 22 segments demonstrated persistent inflammation. Among imaging features, MRI Index of Activity (MaRIA) score <8 (accuracy 85%, sensitivity 89%, specificity 77%) and bowel wall thickness (WT) < 4mm (82%, 87%, 73%) were most strongly associated with MH ( P < 0.0001, Fisher’s Exact Test). The average WT in healing segments was 2.7 + 0.9 mm compared with 5.2 + 2.2 mm in segments with persistent inflammation (P=<0.0001, Student’s t test). Other MRE features significantly (P < 0.005) associated with MH included mesenteric hypervascularity (78%, 97%, 45%), and bowel wall T2 hyperintensity (78%, 92%, 55%).

MRE is an accurate noninvasive technique for assessing mucosal healing in pediatric patients with Crohn’s disease. The MRE features most strongly associated with MH include MaRIA score < 8 and WT < 4 mm.

MRE assessment of mucosal healing has great potential in pediatric Crohn’s disease as a noninvasive imaging biomarker of disease activity and a therapeutic endpoint of clinical trials.

Moy, M, Kaplan, J, Moran, C, Winter, H, Gee, M, Magnetic Resonance Enterography Features of Mucosal Healing in Pediatric Patients with Crohn's Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011963.html