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

OBJECTIVES: To evaluate the clinical usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in children and young adults with Crohn's disease. METHODS: 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. RESULTS: 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). CONCLUSION: 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. KEY POINTS: * 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(trans)value 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(trans)value 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).