MRI-Based Score Helps in Assessing the Severity and in Follow-up of Pediatric Patients With Perianal Crohn Disease

Kulkarni, Sakil*; Gomara, Roberto; Reeves-Garcia, Jesse; Hernandez, Erick; Restrepo, Ricardo

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0000000000000199
Original Articles: Gastroenterology
Abstract

Objectives: The radiologic healing of perianal fistulizing Crohn disease (PfCD) lags behind the clinical healing. Contrast-enhanced pelvic magnetic resonance imaging (MRI) is the radiologic study of choice used to diagnose PfCD in children. The aim was to study whether the various MRI-based radiologic parameters and score can help in staging and follow-up of patients with PfCD.

Methods: We performed a retrospective chart review of children with PfCD who underwent contrast-enhanced MRI of the pelvis. The demographic profile, clinical status, and laboratory data of the patients at the time of each MRI examination were noted. Based on the clinical status of the patient at the time of MRI examinations, the MRIs were classified into 3 groups: severe disease, mild-to-moderate disease, and asymptomatic. Each MRI examination was reviewed by a radiologist, who was blinded to the clinical status of the patient.

Results: Of the radiologic parameters, the number of fistulas, the complexity of fistulas, and the number of abscesses were significantly lower in the asymptomatic group compared with the mild-to-moderate and severe disease groups. The Van Assche MRI-based score was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.01) and the severe disease group (P = 0.002). The percentage increase in fistula activity after gadolinium administration was significantly lower in the asymptomatic group compared with the mild-to-moderate disease (P = 0.026) and severe disease (P = 0.019) groups. The MRI-based scores were significantly higher in the MRI examinations performed at diagnosis compared with those that were performed while the patients were receiving the treatment (P = 0.017).

Conclusions: The Van Assche MRI score and the percentage increase in fistula activity after gadolinium administration help in assessing the severity perianal Crohn disease. The Van Assche MRI score may be helpful in documenting healing during therapy of perianal Crohn disease.

Author Information

*Department of Medical Education

Department of Pediatric Radiology

Department of Pediatric Gastroenterology, Miami Children's Hospital, Miami, FL.

Address correspondence and reprint requests to Sakil Kulkarni, Miami Children's Hospital, 3200 SW 60th Ct, Suite 204, Miami, FL 33155 (e-mail: Sakil.Kulkarni@mch.com).

Received 21 June, 2013

Accepted 2 October, 2013

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,