Debnath Pradipta, Epstein Katherine N, Kocaoglu Murat, Towbin Alexander J, Denson Lee A, Dillman Jonathan R
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Kasota Building MLC 5031, Cincinnati, OH, 45229, USA.
Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.
Abdom Radiol (NY). 2024 Oct;49(10):3354-3363. doi: 10.1007/s00261-024-04314-8. Epub 2024 Apr 24.
(1) To determine the frequency of surgical management in children with Crohn's Disease (CD) and a new radiologic ileal stricture, and (2) to identify imaging and clinical features that predict the need for surgery.
This retrospective study included pediatric patients (< 21 years old) with CD and a new ileal stricture diagnosed by MRE, CTE, or CT between July 2018 and June 2023. Three board-certified radiologists recorded stricture length, maximum mural thickness, minimum lumen diameter, maximum upstream diameter, and simplified magnetic resonance index of activity (sMaRIA) score. Anthropometrics, laboratory data, and surgical interventions performed after stricture diagnosis were also recorded. Multivariable logistic regression was used to identify imaging and clinical variables associated with the need for surgery.
44 pediatric CD patients (median age 16.5 years) presented with a new ileal stricture during the study period. 30 (68.2%) patients required surgery, with a median time of 87.5 days between stricture diagnosis and surgery. Median stricture measurements were length: 7.0 cm, maximum mural thickness: 7.3 mm, minimum lumen diameter: 0.2 cm, and maximum upstream diameter: 3.3 cm. Median sMaRIA score was 3.0, and 14 (31.8%) strictures had associated internal penetrating disease. Stricture ratio (ratio of maximum upstream lumen diameter to minimum lumen diameter) (OR = 1.15 [95% CI 1.02-1.30]; p = 0.02) and sMaRIA (OR = 2.12 [95% CI 0.87-5.17; p = 0.10) were associated with need for surgery.
Surgery remains common in stricturing pediatric CD, with increasing stricture ratio and sMaRIA score associated with need for surgical management.
（1）确定患有克罗恩病（CD）且出现新的放射性回肠狭窄的儿童的手术治疗频率，以及（2）识别预测手术需求的影像学和临床特征。
这项回顾性研究纳入了2018年7月至2023年6月期间通过磁共振肠造影（MRE）、CT小肠造影（CTE）或CT诊断为患有CD且出现新的回肠狭窄的儿科患者（年龄<21岁）。三位获得委员会认证的放射科医生记录狭窄长度、最大肠壁厚度、最小管腔直径、最大上游直径以及简化磁共振活动指数（sMaRIA）评分。还记录了狭窄诊断后的人体测量学数据、实验室数据以及手术干预情况。采用多变量逻辑回归来识别与手术需求相关的影像学和临床变量。
在研究期间，44例儿科CD患者（中位年龄16.5岁）出现了新的回肠狭窄。30例（68.2%）患者需要手术，从狭窄诊断到手术的中位时间为87.5天。狭窄的中位测量值为：长度7.0厘米，最大肠壁厚度7.3毫米，最小管腔直径0.2厘米，最大上游直径3.3厘米。sMaRIA评分的中位数为3.0，14例（31.8%）狭窄伴有肠壁穿透性病变。狭窄比率（最大上游管腔直径与最小管腔直径之比）（比值比[OR]=1.15[95%置信区间1.02 - 1.30]；p=0.02）和sMaRIA（OR=2.12[95%置信区间0.87 - 5.17；p=0.10]）与手术需求相关。
在患有狭窄的儿科CD患者中，手术治疗仍然很常见，狭窄比率增加和sMaRIA评分与手术治疗需求相关。
