OPPORTUNITIES OF MAGNETIC RESONANCE ENTEROGRAPHY
IN THE DIAGNOSIS OF CROHN'S DISEASE IN PEDIATRIC HOSPITAL PRACTICE
Khizhnikova V.V.1, Medvedeva N.A.1,2, Khalilov V.S.1, Alieva E.I.1, Serova N.S.2
1 - Federal Research and Clinical Center for Children and Adolescents.
2 - Sechenov University. Moscow, Russia.
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o determine the diagnostic capabilities of magnetic resonance enterography in identifying and detailing specific intestinal changes in children with Crohn's disease and ulcerative colitis in order to improve diagnosis and enhance the effectiveness of treatment for these diseases in children.
Materials and methods. During 2023-2024, 153 MRI examinations were conducted in the Federal Research and Clinical Center of FMBA of Russia for children aged 7-17 years. 72 of them were diagnosed with Crohn's disease (54% were primary examinations). The procedure was performed in the morning on an empty stomach after a cleansing enema. Oral contrast agent (mannitol) and intravenous contrast (gadolinium) were used. The study was conducted on a GE Signa Creator 1.5T MR tomograph in the prone position. The protocol included T2 and T2 FS sequences, as well as DWI, LAVA, and LAVA flex.
Results. According to MRI data, pathological changes in the intestines characteristic of Crohn's disease were detected in 76 children. According to MR enterography 50% of patients had thickening of the small intestine wall, 26% had narrowing of the lumen, 46% had segmental contrasting, 14% had lymphadenopathy, 20% had fluid in the abdominal cavity, 18% had smoothed haustrations, 1% had interintestinal fistulas and 1% had abscesses. Nonspecific changes included dolichocolon/dolichosigmoid (46%), transverse ptosis (16%) and incomplete intestinal rotation (1%). In cases of extensive changes (presence of abscesses, interintestinal fistulas and involvement of proximal intestinal segments), MR enterography was more informative than endoscopic examination. In some cases, it became the primary examination due to the need for urgent evaluation.
Discussion. For the diagnosis of small intestine diseases such as Crohn's disease, videoscopic methods are used such as enteroscopy and capsule endoscopy. Capsule endoscopy has contraindications and can be replaced by MRI-enterography. However, in Russia MRI-enterography is often performed after general anesthesia in children under 7-9 years of age. Russia lacks a standardized nomenclature for interpreting the results of MRI-enterography, which makes it difficult to accumulate knowledge. Therefore, recommendations for a standardized nomenclature for CT and MRI-enterography in Crohn's disease have been developed. These recommendations include key visualization findings, such as thickening of the intestinal wall, fistulas, fibrofatty proliferation, and others which help in developing treatment plans and monitoring.
Conclusion. MRI is an effective method for diagnosing Crohn's disease in children, detecting thickening of the intestinal wall, narrowing of the lumen, lymphadenopathy and other changes. In Russia, there is no standardized nomenclature for interpreting results, which makes it difficult to compare data and requires further study. MRI provides additional information for accurate treatment and monitoring but it is necessary to clarify the criteria for interpretation and expand its use in pediatrics.
Keywords: MR-enterography, MRI of the small intestine, Crohn's disease.
Corresponding author: Medvedeva N.A., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Khizhnikova V.V., Medvedeva N.A., Khalilov V.S., Alieva E.I., Serova N.S. Opportunities of magnetic resonance enterography in the diagnosis of crohn's disease in pediatric hospital practice. REJR 2025; 15(1):139-149. DOI: 10.21569/2222-7415-2024-15-1-139-149.
Received: 15.12.24 Accepted: 05.02.25