To identify differences between two cohorts of adult and pediatric patients affected by Crohn’s disease (CD), withregard to lesion location in the small intestine and colon-rectum, lesion activity, and prevalence of perianal disease (PD), usingMRI as the main diagnostic tool.MethodsWe retrospectively reviewed 350 consecutive MRI examinations performed between 2013 and 2016 in outpa-tients 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 ofnine different intestinal segments (from jejunum to rectum) and of the anal canal. Intestinal activity was also calculatedusing a validated score. Perianal disease (PD) was staged. Fisher’sexacttestwasusedandtheoddsratio(OR)wascalculated.ResultsTwo hundred and nineteen out of 350 MRI studies (118 adults and 101 children) were included. The prevalence of PDwas 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 pediatricpatients with severe colorectal disease, the prevalence of PD was twofold (86.7% vs 40%;p= 0.072). Using the clinical Montrealclassification for lesion location, no significant differences emerged between the two patient populations.ConclusionsMRI 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.Key Points•To our knowledge, this is the largest morphological comparative study available in the literature using MRI as the maindiagnostic tool to compare adult patients and children with Crohn’sdisease.•Our study showed significant differences between adults and children: a higher prevalence of rectal and perianal fistulousdisease (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 complicationsin pediatric patients.

MRI reveals different Crohn's disease phenotypes in children and adults / Maccioni, Francesca; Bencardino, Davide; Buonocore, Valeria; Mazzamurro, Fabrizio; Viola, Franca; Oliva, Salvatore; Vernia, Piero; Merli, Manuela; Vestri, Anna Rita; Catalano, Carlo; Cucchiara, Salvatore. - In: EUROPEAN RADIOLOGY. - ISSN 0938-7994. - 29:9(2019), pp. 5082-5092. [10.1007/s00330-019-6006-5]

MRI reveals different Crohn's disease phenotypes in children and adults

Maccioni, Francesca
Primo
Writing – Review & Editing
;
Bencardino, Davide
Secondo
Investigation
;
Buonocore, Valeria
Investigation
;
Mazzamurro, Fabrizio
Investigation
;
Viola, Franca
Investigation
;
Oliva, Salvatore
Investigation
;
Vernia, Piero
Investigation
;
Merli, Manuela
Investigation
;
Vestri, Anna Rita
Software
;
Catalano, Carlo
Penultimo
Supervision
;
Cucchiara, Salvatore
Ultimo
Writing – Review & Editing
2019

Abstract

To identify differences between two cohorts of adult and pediatric patients affected by Crohn’s disease (CD), withregard to lesion location in the small intestine and colon-rectum, lesion activity, and prevalence of perianal disease (PD), usingMRI as the main diagnostic tool.MethodsWe retrospectively reviewed 350 consecutive MRI examinations performed between 2013 and 2016 in outpa-tients 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 ofnine different intestinal segments (from jejunum to rectum) and of the anal canal. Intestinal activity was also calculatedusing a validated score. Perianal disease (PD) was staged. Fisher’sexacttestwasusedandtheoddsratio(OR)wascalculated.ResultsTwo hundred and nineteen out of 350 MRI studies (118 adults and 101 children) were included. The prevalence of PDwas 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 pediatricpatients with severe colorectal disease, the prevalence of PD was twofold (86.7% vs 40%;p= 0.072). Using the clinical Montrealclassification for lesion location, no significant differences emerged between the two patient populations.ConclusionsMRI 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.Key Points•To our knowledge, this is the largest morphological comparative study available in the literature using MRI as the maindiagnostic tool to compare adult patients and children with Crohn’sdisease.•Our study showed significant differences between adults and children: a higher prevalence of rectal and perianal fistulousdisease (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 complicationsin pediatric patients.
File allegati a questo prodotto
File Dimensione Formato  
Maccioni_MRI_2019.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 991.55 kB
Formato Adobe PDF
991.55 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11573/1281306
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 12
  • ???jsp.display-item.citation.isi??? 12
social impact