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MR enterography accurately diagnoses active inflammation in children with IBD
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Magnetic resonance enterography showed high accuracy for diagnosing active inflammation in children with known or suspected inflammatory bowel disease, according to a meta-analysis published in JAMA Pediatrics.
Investigators noted that this noninvasive, radiation-free diagnostic showed especially high performance at the per-patient level.
“Magnetic resonance (MR) enterography has rapidly emerged as the diagnostic imaging modality of choice to identify disease involvement and assess disease activity,” investigators wrote. “Magnetic resonance enterography has the advantage of being noninvasive, lacking ionizing radiation, and demonstrating excellent soft-tissue contrast. Because children are more sensitive to ionizing radiation and they have to undergo multiple imaging studies during their lifetime to monitor disease activity, MR enterography is the best radiologic imaging modality in the field of pediatric IBD.”
To systematically assess the diagnostic performance of MR enterography in pediatric IBD, researchers from University of Ulsan College of Medicine, Asan Medical Center, in Seoul, South Korea, reviewed medical literature published up to January 2017, and included 18 studies comprising 687 patients in their analysis. Half of the studies were prospective, and half were retrospective.
Overall, MR enterography diagnosed active inflammation with 83% sensitivity (95% CI; 75%-89%) and 93% specificity (95% CI; 90%-95%), and the area under the hierarchical summary receiver operating characteristic curve was 0.95 (95% CI; 0.93-0.97).
The investigators noted they observed “substantial heterogeneity” in both sensitivity and specificity across individual studies, which showed sensitivities ranging from 53% to 100% and specificities ranging from 50% to 100%.
A per-patient analysis showed MR enterography performed with a pooled 86% sensitivity (95% CI; 78%-91%) and 91% specificity (95% CI; 82%-96%).
Further, a per-lesion analysis showed a pooled sensitivity of 72% (95% CI; 55%-84%) and a specificity of 93% (95% CI; 90%-95%).
An analysis of overall bowel segments showed a pooled sensitivity of 83% (95% CI; 73%-90%) and a specificity of 93% (95% CI; 90%-95%).
Finally, meta-regression analysis showed scanner manufacturer was correlated to clinically meaningful differences in sensitivity (73% in studies using GE Healthcare scanners vs. 93% in studies using Siemens Corp. scanners).
The investigators concluded that MR enterography showed high diagnostic performance for diagnosing active inflammation in children with known or suspected IBD, particularly at the per-patient level.
“We hope that our study might be evidence of justification for the application of MR enterography in this population,” they wrote. – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.
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