Skip to main content
SpringerLink
Log in

Assessment of pediatric Crohn’s disease activity: validation of the magnetic resonance enterography global score (MEGS) against endoscopic activity score (SES-CD)

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study is to evaluate the ability of magnetic resonance enterography global score (MEGS) to diagnose the activity of pediatric Crohn’s disease (CD) and its correlation with endoscopic activity score.

Materials and methods

70 pediatric CD patients (between the ages of 6 and 17) were enrolled who underwent ileocolonoscopy and magnetic resonance enterography (MRE) within 7 days. The simplified endoscopic activity score for Crohn’s disease (SES-CD) and MEGS were acquired in the terminal ileum. Sensitivity and specificity of MEGS for detection disease activity against SES-CD was compared using the McNemar test. The correlation between MEGS and SES-CD was assessed by Spearman's rank estimation. The diagnostic accuracy of MEGS for active disease defined by SES-CD was calculated. Receiver operating characteristic curves (ROC) were constructed.

Results

Fifty-two pediatric CD patients (median age, 12 years old; 28 girls, 24 boys) were included. The incidence of upper gastrointestinal (GI) tract (23%) involvement and perianal lesions (42%) is high in pediatric Crohn’s patients, and most of them suffer from internal hemorrhoids (86.5%). MEGS showed strong correlation to SES-CD (r = 0.70, P < 0.001). With endoscopic as the standard of reference, the MEGS had a high accuracy for the detection of inflammation (area under the ROC curve (AUC) of 0.89, sensitivity 0.95 and specificity 0.82) and for disease activity (AUC of 0.81, sensitivity 0.88 and specificity 0.75) in the terminal ileum.

Conclusion

Pediatric Crohn’s disease is unique. Our study has shown a good correlation between MEGS and endoscopy activity score with equal diagnostic efficacy. MEGS is a promising method to assess disease activity and perhaps be a valuable tool in following therapeutic changes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Benchimol EI, Fortinsky KJ, Gozdyra P, Van den Heuvel M, Van Limbergen J, Griffiths AM (2011) Epidemiology of pediatric inflammatory bowel disease: a systematic review of international trends. Inflamm Bowel Dis 17:423–439.

    Article  Google Scholar 

  2. Van Limbergen J, Russell RK, Drummond HE et al (2008) Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology 135:1114–1122.

    Article  Google Scholar 

  3. Auvin S, Molinie F, Gower-Rousseau C et al (2005) Clinical presentation and location at diagnosis of pediatric inflammatory bowel disease: a prospective population-based study in orthern France (1988–1999). J Pediatric Gastroenterol Nut41:49–55.

    Article  Google Scholar 

  4. Gupta N, Bostrom AG, Kirschner BS et al (2008) Presentation an disease course in early- compared to later-onset pediatric Crohn’s disease. Am J Gastroenterol 103:2092–8.

    Article  Google Scholar 

  5. Levine A, Kugathasan S, Annese V et al (2007) Pediatric onset Crohn’s colitis is characterized by genotype-dependent age-relate susceptibility. Inflamm Bowel 13:1509–1515.

    Article  Google Scholar 

  6. Mary JY, Modigliani R(1989) Development and validation of an endoscopic index of the severity for Crohn’s disease: a prospective multicentre study. Groupe d’Etudes Therapeutiques des Affections Inflammatoires du Tube Digestif (GETAID). Gut 30:983–989.

    Article  CAS  Google Scholar 

  7. Miles A, Bhatnagar G, Halligan S, et al (2019) Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn’s disease: patient acceptability and perceived burden. Eur Radiol.29(3):1083-1093.

    Article  Google Scholar 

  8. Martin DR, Lauenstein T, Sitaraman SV(2007) Utility of magnetic resonance imaging in small bowel Crohn’s disease. Gastroenterology 133:385–390.

    Article  Google Scholar 

  9. Rimola J, Rodriguez S, Garcia-Bosch O, et al(2009) Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 58:1113–1120.

    Article  CAS  Google Scholar 

  10. García-Bosch O, Ordás I, Aceituno M, et al(2016) Comparison of diagnostic accuracy and impact of MRI and colonoscopy for the management of Crohn’s disease. J Crohns Colitis. doi:10. 1093/ecco-jcc/jjw015.

  11. Kopylov U, Klang E, Yablecovitch D, et al(2016) Magnetic resonance enterography versus capsule endoscopy activity indices for quantification of small bowel inflammation in Crohn’s disease. Therap Adv Gastroenterol 9:655–663.

    Article  Google Scholar 

  12. Puylaert CAJ, Nolthenius CJT, Tielbeek JAW, et al. (2019) Comparison of MRI Activity Scoring Systems and Features for the Terminal Ileum in Patients With Crohn Disease.AJR Am J Roentgenol 212(2):W25-W31.

  13. Makanyanga JC, Pendsé D, Dikaios N et al (2014) Evaluation of Crohn’s disease activity: initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 24(2):277–287.

    Article  Google Scholar 

  14. Prezzi D, Bhatnagar G, Vega R, Makanyanga J, Halligan S, Taylor SA (2015) Monitoring Crohn’s disease during anti-TNF-alpha therapy: validation of the magnetic resonance enterography global score (MEGS) against a combined clinical reference standard. Eur Radiol 26 (7):2107–2117.

    Article  Google Scholar 

  15. Steward MJ, Punwani S, Proctor I et al (2012) Non-perforating small bowel Crohn’s disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 81:2080–2088.

    Article  Google Scholar 

  16. Ajaj WM, Lauenstein TC, Pelster G et al (2005) Magnetic resonance colonography for the detection of inflammatory diseases of the large bowel: quantifying the inflammatory activity. Gut 54:257–263.

    Article  CAS  Google Scholar 

  17. Maccioni F, Bencardino D, Buonocore V et al (2019) MRI reveals different Crohn’s disease phenotypes in children and adults. Eur Radiol 29(9):5082-5092 .

    Article  Google Scholar 

  18. Borthne AS, Abdelnoor M, Rugtveit J, Perminow G, Reiseter T, Klow NE (2006) Bowel magnetic resonance imaging of pediatric patients with oral mannitol MRI compared to endoscopy and intestinal ultrasound. Eur Radiol 16:207–214.

    Article  Google Scholar 

  19. Toma P, Granata C, Magnano G, Barabino A(2007) CT and MRI of paediatric Crohn disease. Pediatr Radiol 37:1083–1092.

    Article  Google Scholar 

  20. Paolantonio P, Ferrari R, Vecchietti F, Cucchiara S, Laghi A(2009) Current status of MR imaging in the evaluation of IBD in a pediatric population of patients. Eur J Radiol 69:418–424.

    Article  Google Scholar 

  21. Gee MS, Nimkin K, Hsu M, et al(2011) Prospective evaluation of MR enterography as the primary imaging modality for pediatric Crohn disease assessment. AJR 197:224–231.

    Article  Google Scholar 

  22. Absah I, Bruining DH, Matsumoto JM, et al(2012) MR enterography in pediatric inflammatory bowel disease: retrospective assessment of patient tolerance, image quality, and initial performance estimates. AJR 199:[web]W367–W375.

  23. Maccioni F, Viola F, Carrozzo F, et al(2012) Differences in the location and activity of intestinal Crohn’s disease lesions between adult and paediatric patients detected with MRI. Eur Radiol 22:2465–2477.

    Article  Google Scholar 

  24. Smith EA, Dillman JR, Adler J, Dematos-Maillard VL, Strouse PJ (2012) MR enterography of extraluminal manifestations of inflammatory bowel disease in children and adolescents: moving beyond the bowel wall. AJR 198: W38–W45.

    Article  Google Scholar 

  25. Daperno M, D’Haens G, Van Assche G, et al. Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD.

  26. Moskovitz DN, Daperno M, Van Assche G. Defining and validating cut-offs for the Simple Endoscopic Score for Crohn’s Disease. Gastroenterology. 2007;132:S1097.

    Google Scholar 

  27. Sipponen T, Nuutinen H, Turunen U, et al. Endoscopic evaluation of Crohn’s disease activity: comparison of the CDEIS and the SES-CD. Inflamm Bowel Dis. 2010;16: 2131–2136.

    Article  Google Scholar 

  28. Assa A, Amitai M, Greer ML et al (2017) ImageKids study group. Perianal pediatric Crohn’s disease is associated with a distinct phenotype and greater inflammatory burden. J Pediatr Gastroenterol Nutr 65(3):293–298.

  29. Levine A, Koletzko S, Turner D, et al; European Society of Pediatric Gastroenterology, Hepatology, and Nutrition. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr 2014;58:795-806.

  30. De Bie CI, Paerregaard A, Kolacek S et al (2013) Disease phenotype at diagnosis in pediatric Crohn’s disease: 5-year analyses of the EUROKIDS Registry. Inflamm Bowel Dis 19(2):378–385.

    Article  Google Scholar 

  31. Rimola J, Alvarez-Cofiño A, Pérez-Jeldres T, et al. (2017) Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease. J Gastroenterol 52:585-593.

    Article  Google Scholar 

Download references

Acknowledgements

This work has been supported by Grant 2018-CX-30 from the Fujian provincial health planning commission, China.

Author information

Author notes

  1. Xianying Zheng and Meina Li contributed equally to this study.

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Fujian Medical University, 20 Cha Zhong Rd, Fuzhou, 350000, Fujian, China

    Xianying Zheng, Meina Li, Yinchen Wu & Xuehua Lin

  2. MR, Siemens Healthcare, Shanghai, China

    Zhongshuai Zhang

  3. Department of Gastroenterology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Weiwei Zheng

  4. Department of Pathology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Mi Wang

Authors
  1. Xianying Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meina Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yinchen Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xuehua Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zhongshuai Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Weiwei Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mi Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xianying Zheng.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, X., Li, M., Wu, Y. et al. Assessment of pediatric Crohn’s disease activity: validation of the magnetic resonance enterography global score (MEGS) against endoscopic activity score (SES-CD). Abdom Radiol 45, 3653–3661 (2020). https://doi.org/10.1007/s00261-020-02590-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02590-8

Keywords

Search

Navigation