Magnetic Resonance Enterography Cannot Replace Upper Endoscopy in Pediatric Crohn's Disease: An Imagekids Sub-study

ABSTRACTObjectives:While magnetic resonance enterography (MRE) can accurately reflect ileal inflammation in pediatric Crohn's disease (CD), there are no pediatric data on the accuracy of MRE to detect upper gastrointestinal tract (UGI) lesions. We aimed to compare MRE and esophagogastroduodenoscopy (EGD) in detecting the spectrum and severity of UGI disease in children.Methods:This is an ancillary study of the prospective multi-center ImageKids study focusing on pediatric MRE. EGD was performed within 2 weeks of MRE (at disease onset or thereafter) and explicitly scored by SES-CD modified for the UGI and physician global assessment. Local and central radiologists scored the UGI region of the MRE blinded to the EGD. Accuracy of MRE compared to EGD was examined using correlational coefficients (r) and area under receiver operating characteristic curves (AUC).Results:One-hundred-and-eighty-eight patients were reviewed (mean age 14 ± 1 years, 103 (55%) males); 66/188 (35%) children had macroscopic ulcerations on EGD (esophagus, 13 (7%); stomach, 34 (18%); duodenum, 45 (24%)). Most children had aphthous ulcers, but 10 (5%) had larger ulcers (stomach, 2 (1%); duodenum, 8 (4%)). There was no agreement between local and central radiologists on the presence or absence of UGI inflammation on MRE (Kappa=−0.02, p=0.71). EGD findings were not accurately detected by MRE, read locally or centrally (r=−0.03 to 0.11, p = 0.18 to 0.88; AUC=0.47 to 0.55, p = 0.53 to 1.00).No fistulae or narrowings were identified on either EGD or MRE.Conclusions:MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose. Objectives: While magnetic resonance enterography (MRE) can accurately reflect ileal inflammation in pediatric Crohn's disease (CD), there are no pediatric data on the accuracy of MRE to detect upper gastrointestinal tract (UGI) lesions. We aimed to compare MRE and esophagogastroduodenoscopy (EGD) in detecting the spectrum and severity of UGI disease in children. Methods: This is an ancillary study of the prospective multi-center ImageKids study focusing on pediatric MRE. EGD was performed within 2 weeks of MRE (at disease onset or thereafter) and explicitly scored by SES-CD modified for the UGI and physician global assessment. Local and central radiologists scored the UGI region of the MRE blinded to the EGD. Accuracy of MRE compared to EGD was examined using correlational coefficients (r) and area under receiver operating characteristic curves (AUC). Results: One-hundred-and-eighty-eight patients were reviewed (mean age 14 ± 1 years, 103 (55%) males); 66/188 (35%) children had macroscopic ulcerations on EGD (esophagus, 13 (7%); stomach, 34 (18%); duodenum, 45 (24%)). Most children had aphthous ulcers, but 10 (5%) had larger ulcers (stomach, 2 (1%); duodenum, 8 (4%)). There was no agreement between local and central radiologists on the presence or absence of UGI inflammation on MRE (Kappa=−0.02, p=0.71). EGD findings were not accurately detected by MRE, read locally or centrally (r=−0.03 to 0.11, p = 0.18 to 0.88; AUC=0.47 to 0.55, p = 0.53 to 1.00).No fistulae or narrowings were identified on either EGD or MRE. Conclusions: MRE cannot reliably assess the UGI in pediatric CD and cannot replace EGD for this purpose. Address correspondence and reprint requests to Peter C. Church, MD, FRCPC, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8 (e-mail: peterchurch@gmail.com). Received 12 May, 2017 Accepted 4 December, 2017 Conflicts of Interest and source of funding: No author had any conflict of interest in relation to the content of this manuscript. The ImageKids study (clinicaltrials.gov NCT01881490) was supported by a grant from AbbVie. ImageKids Study collaborators: George Alex, Michal M. Amitai, Sudha Anupindi, Elhamy Bekhit, Eric Benchimol, Laureline Berteloo, Eva Coppenrath, Jorge Davila, Lissy de Ridder, Lee A. Denson, Larisa Duchano, Hankje Escher, David Grand, Izabela Herman-Sucharska, Holger Hetterich, Jessie Hulst, Anat Ilivitzki, Judith Kelsen, Sibylle Koletzko, Osnat Konen, Karen Lambot, Neal LeLeiko, Daniel A. Lemberg, Maarten Lequin, David Mack, Javier Martin de Carpi, Maria Martínez-León, M. Luisa Mearin, Doug Moote, Daniel Moses, Kathy O'Brien, Lucia Riaza, Firas Rinawi, Frank Ruemmele, Richard Russell, Raanan Shamir, Ron Shaoul, Jared Silverstein, Emily Stenhouse, Alexander Towbin, Thomas D. Walters, Martin Wasser Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.jpgn.org). © 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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