Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Policlinico Umberto I Hospital , Viale del Policlinico, 155, 00161, Rome, Italy.
Department of Pediatrics and Pediatric Neuropsychiatry, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale del Policlinico, 155, 00161, Rome, Italy.
Eur Radiol. 2019 Sep;29(9):5082-5092. doi: 10.1007/s00330-019-6006-5. Epub 2019 Feb 7.
To identify differences between two cohorts of adult and pediatric patients affected by Crohn's disease (CD), with regard to lesion location in the small intestine and colon-rectum, lesion activity, and prevalence of perianal disease (PD), using MRI as the main diagnostic tool.
We retrospectively reviewed 350 consecutive MRI examinations performed between 2013 and 2016 in outpatients or inpatients with histologically proven CD, monitored by the Gastroenterology and Pediatric Units of our Hospital. The magnetic resonance enterography (MRE) protocol for adult and pediatric CD patients routinely includes evaluation of nine different intestinal segments (from jejunum to rectum) and of the anal canal. Intestinal activity was also calculated using a validated score. Perianal disease (PD) was staged. Fisher's exact test was used and the odds ratio (OR) was calculated.
Two hundred and nineteen out of 350 MRI studies (118 adults and 101 children) were included. The prevalence of PD was 34.6% in children and 16.1% in adults (OR = 2.8; p = 0.0017). Pediatric patients showed more frequent rectal involvement (29.7% vs 13.5%, OR = 2.7; p = 0.0045) and higher risk of PD in the presence of rectal disease (p = 0.043; OR = 4.5). In pediatric patients with severe colorectal disease, the prevalence of PD was twofold (86.7% vs 40%; p = 0.072). Using the clinical Montreal classification for lesion location, no significant differences emerged between the two patient populations.
MRI showed a significantly higher prevalence of rectal involvement and perianal disease in the pediatric population. These results may have a relevant clinical impact and deserve further investigation.
• To our knowledge, this is the largest morphological comparative study available in the literature using MRI as the main diagnostic tool to compare adult patients and children with Crohn's disease. • Our study showed significant differences between adults and children: a higher prevalence of rectal and perianal fistulous disease (PD) in pediatric patients and an increased prevalence of PD in the presence of severe colon-rectum involvement. • The association of rectal and perianal disease implies a poorer clinical prognosis and a higher risk of disabling complications in pediatric patients.
使用 MRI 作为主要诊断工具，比较两组成人和儿科克罗恩病（CD）患者的小肠和结肠直肠病变部位、病变活动度和肛周疾病（PD）的发生率。
我们回顾性分析了 2013 年至 2016 年间在我院胃肠科和儿科门诊或住院的经组织学证实的 CD 患者的 350 例连续 MRI 检查。成人和儿科 CD 患者的磁共振肠造影（MRE）方案常规包括 9 个不同肠段（空肠至直肠）和肛门管的评估。还使用经过验证的评分计算肠道活动度。分期肛周疾病（PD）。使用 Fisher 确切检验，计算比值比（OR）。
350 例 MRI 研究中有 219 例（118 例成人和 101 例儿童）纳入研究。儿童 PD 的患病率为 34.6%，成人 PD 的患病率为 16.1%（OR=2.8；p=0.0017）。儿科患者直肠受累更为常见（29.7%比 13.5%，OR=2.7；p=0.0045），且直肠疾病存在时 PD 的风险更高（p=0.043；OR=4.5）。在严重结直肠疾病的儿科患者中，PD 的患病率为 2 倍（86.7%比 40%；p=0.072）。使用病变部位的临床蒙特利尔分类，两组患者之间没有显著差异。
MRI 显示儿科人群直肠受累和肛周疾病的患病率明显更高。这些结果可能具有重要的临床意义，值得进一步研究。
•据我们所知，这是使用 MRI 作为主要诊断工具比较成人患者和儿童克罗恩病的文献中最大的形态学比较研究。•我们的研究显示了成人和儿童之间的显著差异：儿科患者直肠和肛周瘘管性疾病（PD）的患病率较高，且严重结肠直肠受累时 PD 的患病率增加。•直肠和肛周疾病的相关性提示儿科患者的临床预后较差，且发生致残性并发症的风险较高。
