Quantitative evaluation of Crohn's disease using dynamic contrast-enhanced MRI in children and young adults.

Abstract

To evaluate the clinical usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in children and young adults with Crohn's disease. From August 2017 to October 2018, 30 patients with Crohn's disease (21 males and 9 females; mean age 15.1 ± 2.5 years) underwent DCE-MRI with MRI enterography. We assessed the endoscopic finding, pediatric Crohn's disease activity index (PCDAI), C-reactive protein (CRP) level (mg/dL), Crohn's disease MR index (CDMI) score, and the perfusion parameters of DCE-MRI (K^trans, K^ep, and V^e) at the ileocecal region between the inactive and active groups based on the histopathologic status. The active Crohn's disease group showed higher PCDAI, CRP, and CDMI scores than the inactive group (22.2 ± 18.8 vs. 6.3 ± 6.4, p = 0.027; 1.32 ± 1.79 vs. 0.10 ± 0.13, p = 0.005; 7.4 ± 3.9 vs. 4.5 ± 3.0, p = 0.047, respectively). The active Crohn's disease group showed a higher K^trans value than the inactive group (0.31  ±  0.12 vs. 0.16 ±  0.46 min^-1, p = 0.002). Endoscopic finding; PCDAI, CRP, and CDMI scores; and K^trans value were significant parameters in the identification of the active Crohn's disease (p = 0.002, p < 0.001, p = 0.029, p = 0.006, and p < 0.001, respectively). K^trans value was the most significant value for identifying active Crohn's disease in the multivariate logistic regression analysis (p = 0.013). K^trans value could discriminate between inactive and active Crohn's diseases. K^trans value may have the potential to monitor the pediatric Crohn's disease activity. • With dynamic contrast-enhanced MRI, we can quantitatively monitor the Crohn's disease status in pediatric patients and provide proper management plans to clinicians. • The K^transvalue of dynamic contrast-enhanced MRI perfusion parameter, as well as the clinical pediatric Crohn's disease activity index, C-reactive protein level, the endoscopic score, and the Crohn's disease MR index, was higher in the active Crohn's disease than in the inactive group based on the histopathologic status. • The K^transvalue among the dynamic contrast-enhanced MRI perfusion parameters was the most significant differentiating parameter for the active Crohn's disease from inactive status among those parameters (p = 0.013).