engleski

Accuracy of imaging scoring indexes in paediatric Crohn’s disease patients.

Introduction: Crohn’s disease (CD) is a chronic inflammatory disorder that affects the gastrointestinal tract, predominantly involving the small intestine and colon. Up to 66 % of patients with Crohn’s disease have small-bowel involvement at diagnosis. In approximately 90 % of patients with small-bowel Crohn’s disease, the disease involves the terminal ileum. Ileocolonoscopy is gold standard in diagnosis of ileocolonic disease but skip lesions and proximal involvement can be evaluated only be meaning of capsule endoscopy (VCE) and or MR enterography (MRE). Aims & Objectives: our aim was to correlate findings obtained from MRE and VCE with Paediatric Crohn’s disease Activity Index (PDCAI) at the time of disease presentation. Methods: At single-centre, tertiary care hospital centre we prospectively enrolled consecutive paediatric patients with newly diagnosed Crohn’s diseases admitted to the Department of Pediatrics in Clinical Hospital Centre Rijeka from December 2010 to December 2015. All the patients had undergone upper and lower endoscopy in deep sedation. PCDAI was made at the time of admission. All patients after endoscopy investigation with suspected small bowel involvement underwent MRE and VCE. MRE and VCE findings were evaluated by using Crohn disease MRI index (CDMI) score and the Capsule Endoscopy Crohn’s Disease Activity Index (CECDAI or Niv score) respectively. VCE was performed using PillCam SB 3 with Rapid software. MR enterography protocol was performed on 1.5 T MRI system with combined built in spine array coli and two wrapped around flexible surface coils. We performed next sequences: HASTE (ST = 100 mm), true FISP: +FS/-FS, HASTE: +FS/-FS ; ST = 6 mm, true FISP (axial), DWI, after contrast administration (Gadolinium), VIBE and true FISP, T1. Statistical analysis were performed using Spearman's coefficient of rank correlation. Results: A total of 38 patients, 13 girls (34.2%), median age 14 (95%CI 13-15) were evaluated. During the VCE examination, cecum was reached in all patients. According to PCDAI, 11 patients (28.9%) had inactive disease, 17 (44.7%) had mild disease, while 5 (13.1%) had moderate and 5 (13.1%) severe disease. We found statistically significant correlation between PCDAI-CECDAI (R=0.595 ; 95%CI 0.31-0.77 ; P=0.0003) and PCDAI-CDMI (R=0.501 ; 95%CI 0.18-0.72). In addition CECDAI and CDMI have significant correlation (R=0.480 ; 95%CI 0.18-0.69 ; P=0.0026). Conclusions: PCDAI is clinically well- established parameter in evaluating disease severity, but with no adequate reliability in detecting mucosal inflammation. Mucosal inflammation can be be assessed with VCE and MRI, which both have statistically significant correlation with clinical activity index. CECDAI score is reliable tool in detecting mucosal inflammation is pediatric CD patients.

IBD, VCE

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