Application of magnetic resonance enterography in pediatric inflammatory bowel disease
Objective To analyze the imaging findings of pediatric inflammatory bowel disease(PIBD)on magnetic reso-nance enterography(MRE)and to explore the application value of MRE in the diagnosis and evaluation of PIBD.Methods A total of 80 children suspected PIBD in the Gastroenterology Department of Jinan Children's Hospital from January 1,2018 to September 30,2022 were selected for MRE examination.According to the disease diagnosis,they were divided into Crohn's disease group(CD group,21 cases)and ulcerative colitis group(UC gourp,39 cases).Kappa analysis was used to analyze the diagnostic sensitivity,specificity and diagnostic coincidence rate of MRE in children with inflammatory bowel disease.The mean apparent diffusion coefficients(ADC)of active intestinal segments and non-active intestinal segments was analyzed by t-test,and the relationship between ADC value and inflammatory activity was analyzed by Pearson rank correlation.Results Among 80 children,78 completed MRE examination,and 55 cases of PIBD were diagnosed by MRE.With endoscopic and pathological diagnosis as the gold standard,the sensitivity of MRE to PIBD was 88.3％(53/60,95％CI:0.800-0.967),specificity 88.9％(16/18,95％CI:0.728-1.050),positive predictive value 96.4％(53/55,95％CI:0.913-1.015),negative predictive value 69.6％(16/23,95％CI:0.492-0.899),and diagnostic coincidence rate 88.5％(69/78,95％CI:0.812-0.957).The kappa coefficient between MRE and endoscopy was high(Kappa=0.704,P＜0.001).The characteristic imaging findings of active PIBD on MRE mainly included wall thickening,T2WI hyperin-tensity,abnormal strengthening of the intestinal wall and DWI hyperintensity in the affected bowel wall.Lymph node en-largement was the most common extraintestinal manifestation.The mean ADC value of the inflammatory active intestine(1.25±0.32)× 10-3 mm2/s was lower than that of the inactive intestine(1.80±0.23)× 10-3 mm2/s in CD group(t=-6.918,P＜0.001).The Pediatric Crohn's Disease Activity Index(PCDAI)scores were moderately negatively correlated with the ADC values(r=-0.618,P=0.003).The mean ADC value of the inflammatory active intestine(1.24±0.34)× 10-3 mm2/s was lower than that of the inactive intestine(1.87±0.23)× 10-3 mm2/s in UC group(t=-12.31,P＜0.001).The Pediatric Ulcerative Colitis Activity Index(PUCAI)scores were moderately negatively correlated with the ADC values(r=-0.664,P＜0.001).No serious complications happened in all the children undergoing MRE examina-tion.Conclusion MRE has high accuracy and good safety in the PIBD diagnosis,and its ADC value is negatively correlated with the inflammatory activity,which can be used as the preferred method in the PIBD examination evaluation and follow-up.
magnetic resonance enterographychildreninflammatory bowel diseasediagnose
NETL
NSTL
万方数据
