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Comparison of Magnetic Resonance Enterography With Endoscopy, Histopathology, and Laboratory Evaluation in Pediatric Crohn Disease

Sauer, Cary G.*; Middleton, Jeremy P.*; Alazraki, Adina; Udayasankar, Unni K.; Kalb, Bobby§; Applegate, Kimberly E.; Martin, Diego R.||; Kugathasan, Subra*

Journal of Pediatric Gastroenterology and Nutrition: August 2012 - Volume 55 - Issue 2 - p 178–184
doi: 10.1097/MPG.0b013e3182598465
Original Articles: Gastroenterology

Background and Objective: Children with Crohn disease (CD) often undergo cross-sectional imaging during clinical evaluation. Magnetic resonance enterography (MRE) is becoming the preferred radiologic assessment due to the lack of radiation exposure; however, there are few data in children with CD comparing MRE with objective disease measures. The aim of the present study was to compare MRE with endoscopy, histopathology, and laboratory evaluation in children with CD.

Methods: We performed an institutional review board–approved query of our prospective CD MRE database, which includes data in children with CD undergoing MRE since 2008.

Results: A total of 147 MRE studies were performed in 119 different children with symptomatic CD. Of those, 53 (39.6%) MRE studies were performed at diagnosis to evaluate small bowel disease burden. A total of 117 (79.6%) MRE studies displayed active and/or chronic disease, whereas 30 (20.4%) MRE studies were normal. When compared with normal MRE studies, active inflammation on MRE was associated with a higher mean C-reactive protein (3.6 vs 1.1, P < 0.001), higher erythrocyte sedimentation rate (36 vs 22, P = 0.0.31), higher platelet value (439 vs 352, P = 0.033), and lower albumin (3.4 vs 3.7, P = 0.049). Comparison between MRE and endoscopy demonstrated excellent agreement when ulcers were present, and moderate agreement with histopathology.

Conclusions: Active inflammation on MRE is associated with higher C-reactive protein, erythrocyte sedimentation rate, platelets, and lower albumin in children with CD. MRE displays excellent agreement with endoscopic disease described by ulcers but poor agreement with mild mucosal disease described by erythema and friability. The present study adds to a growing body of evidence that MRE provides excellent assessment of inflammation and measures disease activity in CD.

*Division of Pediatric Gastroenterology Hepatology and Nutrition

Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA

Division of Pediatric Radiology, Cleveland Clinic, Cleveland, OH

§Department of Radiology

||Department of Radiology, University of Arizona School of Medicine, Tucson, AZ.

Address correspondence and reprint requests to Cary Sauer, MD, MSc, Emory University School of Medicine, Children's Hospital of Atlanta, Atlanta, GA 30322 (e-mail:

Received 13 January, 2012

Accepted 9 April, 2012

The present study was funded by Emory Egleston Children's Research Center Seed Grant.

The authors report no conflicts of interest.

© 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,