Sauer Cary G, Middleton Jeremy P, McCracken Courtney, Loewen Jonathan, Braithwaite Kiery, Alazraki Adina, Martin Diego R, Kugathasan Subra
*Emory University School of Medicine Department of Pediatrics †Children's Healthcare of Atlanta ‡Department of Pediatrics, University of Virginia Health System §Division of Bioinformatics, Emory and Children's Research Center, Atlanta, GA ||Division of Pediatric Radiology, Emory University Department of Pediatrics ¶Division of Radiology, Arizona University School of Medicine, Tucson.
J Pediatr Gastroenterol Nutr. 2016 Mar;62(3):378-83. doi: 10.1097/MPG.0000000000000976.
Mucosal healing predicts clinical remission and improved outcomes in patients with Crohn disease (CD). Magnetic resonance enterography (MRE) is a noninvasive imaging modality that can assess small and large bowel wall inflammation. Evidence suggests that MRE may be an acceptable alternative to evaluate mucosal healing over endoscopy. Our objective is to determine whether MRE remission predicts clinical remission at follow-up in children with CD.
We performed an institutional review board-approved retrospecitve chart review using our prospectively maintained MRE CD database. Inclusion criteria were all children who underwent an MRE more than 6 months after diagnosis with CD who had follow-up of at least 1 year from imaging.
A total of 101 children with CD underwent MRE, a median of 1.3 years from diagnosis with a median follow-up of 2.8 years after MRE. Active inflammation was detected in 65 MRE studies, whereas 36 MRE studies demonstrated MRE remission. A total of 88.9% of children demonstrating MRE remission were in clinical remission at follow-up, whereas only 44.6% of those demonstrating MRE active inflammation achieved clinical remission. Children demonstrating MRE-active inflammation were more likely to have a change in medication (44.6% vs 8.3%) and more likely to undergo surgery (18.5% vs 2.8%).
MRE remission is associated with clinical remission at follow-up at least 1 year after MRE. MRE remission was associated with fewer medication changes and fewer surgeries suggesting that, similar to endoscopic remission, MRE remission demonstrates improved outcome. Additional research is needed to confirm that MRE can be used as a surrogate for mucosal healing.
黏膜愈合可预测克罗恩病（CD）患者的临床缓解及改善预后。磁共振肠造影（MRE）是一种可评估小肠和大肠壁炎症的非侵入性成像方式。有证据表明，MRE可能是一种可接受的替代方法，用于在内镜检查之外评估黏膜愈合情况。我们的目的是确定MRE缓解是否能预测CD患儿随访时的临床缓解情况。
我们使用前瞻性维护的MRE CD数据库进行了一项经机构审查委员会批准的回顾性图表审查。纳入标准为所有在诊断为CD后6个月以上接受MRE检查且自成像起至少随访1年的儿童。
共有101例CD患儿接受了MRE检查，自诊断起的中位时间为1.3年，MRE检查后的中位随访时间为2.8年。65项MRE研究检测到活动性炎症，而36项MRE研究显示MRE缓解。显示MRE缓解的患儿中，88.9%在随访时处于临床缓解状态，而显示MRE活动性炎症的患儿中只有44.6%实现了临床缓解。显示MRE活动性炎症的患儿更有可能改变用药（44.6%对8.3%），也更有可能接受手术（18.5%对2.8%）。
MRE缓解与MRE检查后至少1年随访时的临床缓解相关。MRE缓解与较少的用药改变和较少的手术相关，这表明与内镜缓解相似，MRE缓解显示出更好的预后。需要进一步研究以证实MRE可作为黏膜愈合的替代指标。
