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P279. MR enterography to guide treatment in children with Crohn's disease in the small bowel

M.L. Piekkala, T. Kalajoki-Helmiö, L. Martelius, M. Pakarinen, R. Rintala, K. Kolho

Helsinki University Central Hospital, Helsinki, Finland

Aim: The aim was to show how MR enterography impacts to the treatment decisions of pediatric patients with Crohn's jejunoileitis.

Subjects and Methods: 22 children with Crohn's disease (age 14.5 years (median); disease duration 2.0 years) were studied. Patients were scheduled to MR enterography to evaluate small bowel involvement. All MR enterographies were performed at the Children's Hospital, Helsinki, a tertiary care university hospital of Finland, and these children were the first to undergo MR enterography. MR was carried out with a Philips 1.5 T Achieva unit. Children drank 70% sorbitol to maximize luminal distension. Gadolinium derivative gadoterate meglumine was used for contrast enhancement of the bowel wall.

Results: The terminal ileum of all patients who completed the procedure (21/22) was visualized in MR enterography. MR pointed inflammation in the terminal ileum in 11 patients (11/21), and in the jejunum in 4 patients. The treatment of Crohn's disease was adjusted according to the MR result in 61% (13/21) of the cases and four patients were sent to additional investigations. Eight patients underwent intestinal resections (8/21; 38%), the macroscopic findings in the intestine being in line with the MR results (Table 1). In the non-operated patients the MR findings corresponded to findings in ileocolonoscopy and were comparable to findings in wireless capsule endoscopy or revealed more extensive disease. In four patients (4/21; 19%) MR had no impact to treatment.

Conclusions: MR enterography successfully identifies small bowel involvement in young patients with Crohn's disease and may guide treatment decisions on surgery or on medical adjustment for pediatric patients.

Table 1. MR enterography findings in the small bowel related to macroscopic findings in intestinal R
Patient no.Time interval between MRI and operation (months)MRI findingsThe length of ileum resecateFindings in intestinal resection
12.5Wall is thickened 25 cm proximal from the valvula Bauchini30 cmThe terminal ileum inflamed sparing 1–2 cm proximally from the ileocaecal angle
21.8Wall of ileum and jejunum is thickened23 cmThe terminal ileum inflamed (10 cm)
32.3The ileum terminale (15–20 cm) is thickened and enhanced22 cmThe ileocaecal angle and the terminal ileum inflamed
44.1The terminal ileum inflamed (15 cm), one ulcer20 cmThe terminal ileum is destructed (20 cm), a stricture 10 cm apart
59.7The terminal ileum is thickened (10 cm); jejunum regions (12 cm and 6 cm) thickened16 cmThe terminal ileum inflamed; two lesions with a length of approximately 5–10 cm in the jejunum
62.5The terminal ileum is thickened and enhanced (12 cm)17 cmThe terminal ileum inflamed
77.7Valvula Bauchini enhanced10 cmThe terminal ileum (including valvula Bauchini) is inflamed (5 cm)
82.5No specific findings in the ileum, but enhancement and thickening in the colon, ulcerationsIleum healthy, colectomyInflamed colon distally from the rectum (promontorium)