P280 Comparison of MR enteroclysis and MR enterography findings with endoscopic findings in paediatric patients with small bowel disease
P. Karanika*1, I. Tsitouridis2, A. Kalampakas3, M. Fotoulaki4
1Papageorgiou Hospital, Paediatric Gastroenterology, Thessaloniki, Greece, 2Papageorgiou Hospital, Radiology Department, Thessaloniki, Greece, 3Papageorgiou Hospital, Endoscopy Unit, Thessaloniki, Greece, 4Papageorgiou, Hospital, Thessaloniki, Greece
The purpose of this study was to evaluate the efficacy of MR enterography and MR enteroclysis in paediatric patients with suspected small bowel disease compared to ileocolonoscopy and histology. The route of contrast administration, the image quality and bowel distention, the side effects, and performance estimates of MR enterography and MR enteroclysis were also evaluated.
A retrospective analysis of the pediatric gastroenterology clinic database (2010-2014) was performed. Thirty-four MR enterography studies and eleven MR enteroclysis studies in thirty-six patients were performed without sedation. The main indications were obscure gastrointestinal bleeding (n = 5), suspected Crohn's disease (n = 25), suspected eosinophilic gastroenteropathy (n = 3) and familial polyposis (n = 3). A water solution containing mannitol 5% was administered orally or through a nasojejunal tube. Patients were imaged on a 1.5-T MR scanner with T1-weighted and T2-weighted sequences. Retrospectively, image quality, mucosal lesions and inflammation were assessed. Correlation between radiographic findings and endoscopic findings was tested by the Fisher exact test.
Thirty-four MR enterography studies and eleven MR enteroclysis studies in thirty-six patients were performed without sedation (mean age, 11.6 years; age range, 4-16 years) over 48 months. Patients who failed to cooperate or drink the contrast media were selected for MR enteroclysis. The Results of the MRE were compared to the colonoscopy and pathology reports to determine the presence or absence of disease in evaluable bowel segments. Individual imaging parameters (including wall thickening, enhancement, T2 signal) were also separately analyzed to determine their independent predictive value. The amount of oral contrast material ingested correlated with patient age (p = 0.005), with acceptable bowel distention occurring in 86%. Four patients had nausea or emesis following oral administration of the contrast agent. The overall sensitivity and specificity of MRE (using endoscopy as a gold standard) were 82% and 76% respectively (kappa=0.64).Sensitivity and specificity of MR enterography and MR enteroclysis for active disease of the terminal ileum, right colon, and left colon were 89% and 84.2%, 70,2% and 68,2%, and 91.2% and 68.6%, respectively.
MR enterography and MR enteroclysis is feasible in patients 5 years old and older without sedation. Small minority will have suboptimal bowel distention or minor adverse events. MRE compares favorably to ileocolonoscopy for evaluation of known or suspected Crohn's disease noninvasively.