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P120. Magnetic resonance enterography (MRE) in children with Crohn's disease: Results from the Belgian Pediatric Crohn's Registry (Belcro)

P. Alliet1, B. Hauser2, E. Janssens1, E. De Greef2, F. Smets3, I. Paquot4, G. Veereman5

1Jessaziekenhuis, Hasselt, Belgium; 2UZ Brussel, Brussel, Belgium; 3UCL St Luc, Brussel, Belgium; 4CHC Clinique de l'Esperance, Liège, Belgium; 5UZ Brussels, Brussels, Belgium

Objectives and Study: Magnetic Resonance enterography (MRE) is an interesting non-invasive imaging modality avoiding ionizing radiation and the discomfort associated with enteroclysis. Results of MRE at diagnosis in the patients of the Belgian Pediatric Crohn's Registry (Belcro) are compared to endoscopic and histologic results.

Methods: Patients in whom MRE was done at diagnosis were selected. Reports of MRE, endoscopy and histology were retrospectively analysed. MRE abnormalities were assigned to one of the following segments: upper GI tract, jejunum, ileum, ascending colon, transverse colon, descending colon and rectosigmoid. All patients underwent upper and lower endoscopy with biopsies.

Results: 22/256 patients included in Belcro had MRE at diagnostic work-up. The results of endoscopy, histology and MRE were concordant (either all negative or all positive) in the rectosigmoid, descending colon, transverse colon and ascending colon in resp 9, 8, 8 and 8 of 22 patients. In the cases with negative MRE in the colon but positive endoscopy and/or histology, subtle endoscopic lesions such as erosions were described. Findings in the ileum were concordant in 16/17 patients and MRE describes the length of ileal involvement. In 5 cases the ileocaecal valve could not be intubated. In all those patients MRE findings were abnormal. MRE detected ileal stenosis with prestenotic dilatation in 4/22 patients. The jejunum was affected in 3/22 patients and fistula were described in 2/22 children.

Conclusions: In this cohort, MRE fails to detect subtle endoscopic and histologic colonic lesions. In contrast, good concordance was seen at the level of the ileum. MRE describes the extent of ileal involvement, the (non)occurrence of ileal stenosis and is of additional diagnostic use in case of failure of intubation of the ileocaecal valve. It also describes jejunal involvement and the occurrence of fistula, enabling a better classification according to the Montreal criteria. MRE was not widely used in Belcro at diagnosis but is now increasingly in the prospective part of the registry.