Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Pediatr Radiol. 2024 Oct;54(11):1842-1849. doi: 10.1007/s00247-024-06056-7. Epub 2024 Sep 18.
Radiologic ulcers are increasingly recognized as an imaging finding of bowel wall active inflammation in Crohn disease (CD).
To determine the frequency of ulcers at MR enterography (MRE) in children with newly diagnosed ileal CD, assess agreement between radiologists, and evaluate if their presence correlates with other imaging and clinical features of intestinal active inflammation.
This retrospective study included 108 consecutive pediatric patients (ages 6-18 years) with newly diagnosed ileal CD that underwent clinical MRE prior to treatment initiation between January 2021 and December 2022. MRE examinations were independently reviewed by three pediatric radiologists who indicated the presence vs. absence of ulcers, ulcer severity (categorical depth), and ulcer extent (categorical number of ulcers). Maximum bowel wall thickness and length of disease were measured and averaged across readers. Patient demographics and clinical inflammatory markers were documented from electronic health records. Inter-radiologist agreement was assessed using Fleiss' kappa (k) statistics. Student's t-test was used to compare continuous variables.
Mean patient age was 13.9 years (67 [62%] boys). Radiologic ulcers were recorded in 64/108 (59.3%) cases by reader 1, 70/108 (64.8%) cases by reader 2, and 49/108 (45.4%) cases by reader 3 (k = 0.36). Based on majority consensus, radiologic ulcers were present in 60/108 (55.6%) participants. Inter-radiologist agreement for ulcer severity was k = 0.23, while ulcer extent was k = 0.66. There were significant differences in C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, albumin, maximum bowel wall thickness, and length of disease between patients without and with radiologic ulcers (P < 0.05). The sensitivity and specificity of MRE for detecting endoscopic ulcers were 66.7% (95% CI, 52.1-79.2%) and 69.2% (95% CI, 48.2-85.7%), respectively.
Radiologic ulcers are visible in children with newly diagnosed ileal CD, although inter-radiologist agreement is only fair. The presence of ulcers is associated with clinical laboratory inflammatory markers as well as other MRE findings of disease activity and is an additional imaging finding that can be used to evaluate intestinal inflammation.
放射学溃疡越来越被认为是克罗恩病（CD）肠壁活动炎症的影像学表现。
确定新诊断的回肠 CD 患儿在磁共振肠造影（MRE）中出现溃疡的频率，评估放射科医生之间的一致性，并评估其存在是否与肠活动炎症的其他影像学和临床特征相关。
这项回顾性研究纳入了 2021 年 1 月至 2022 年 12 月期间在治疗前接受临床 MRE 检查的 108 例新诊断的回肠 CD 患儿，这些患儿年龄为 6-18 岁。3 名儿科放射科医生对 MRE 检查结果进行了独立评估，评估内容包括溃疡的存在/不存在、溃疡的严重程度（分类深度）和溃疡的程度（分类溃疡数量）。在三位读者之间测量并平均了最大肠壁厚度和疾病长度。从电子健康记录中记录了患者的人口统计学和临床炎症标志物数据。采用 Fleiss' kappa（k）统计评估了放射科医生之间的一致性。采用 Student's t 检验比较了连续变量。
患者平均年龄为 13.9 岁（67 名男孩，62%）。第 1 位读者记录了 64/108（59.3%）例放射学溃疡，第 2 位读者记录了 70/108（64.8%）例放射学溃疡，第 3 位读者记录了 49/108（45.4%）例放射学溃疡（k=0.36）。根据多数共识，108 例中有 60 例（55.6%）存在放射学溃疡。溃疡严重程度的放射科医生间一致性为 k=0.23，而溃疡程度的一致性为 k=0.66。无放射学溃疡与有放射学溃疡的患者之间，C 反应蛋白、红细胞沉降率、粪便钙卫蛋白、白蛋白、最大肠壁厚度和疾病长度均有显著差异（P<0.05）。MRE 检测内镜下溃疡的灵敏度和特异性分别为 66.7%（95%CI，52.1-79.2%）和 69.2%（95%CI，48.2-85.7%）。
新诊断的回肠 CD 患儿中可观察到放射学溃疡，但放射科医生之间的一致性仅为中等。溃疡的存在与临床实验室炎症标志物以及其他 MRE 活动疾病发现相关，是评估肠道炎症的另一种影像学发现。
