E1086. Role of MR Enterographies in Endoscopically Silent Diseases in Pediatric Patients
  1. Saba Mohsin; Alberta Children Hospital
  2. Leanna Mackenzie; Alberta Children Hospital
  3. Samarjeet Bhandal; Alberta Children Hospital
Crohn’s Disease is a chronic inflammatory condition that involves the small bowel in 60-70% of patients. Small bowel involvement has a negative impact on the long-term outcome. It is important to closely monitor these patients with MRE and endoscopy as disease progression due to structural damage may require surgical resection. Small bowel involvement increases to 61% after 5 years of disease.

Educational Goals / Teaching Points
To emphasize role of MR Enterography in patients with negative Ileo-colonoscopic findings, to guide treating physician to escalate treatment in clinically and serologically negative patients. Positive findings on MR Enterography can initiate treatment in such patients.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A time-efficient combination of HASTE, true FISP, and VIBE pulse sequences can be used to demonstrate most manifestations of enteric Crohn disease. MR imaging shows acute wall edema, mesenteric edema, fat wrapping, pseudosacculations and fistula and sinuses very well. However, early and superficial ulceration is not well demonstrated even with full luminal distention at MR imaging. Involvement of small bowel beyond terminal ileum is only seen in MR enterography, as these areas can be missed on routine endoscopy.

Enterography is additional imaging modality besides ileocolonoscopy in evaluation and follow-up of pediatric inflammatory bowel diseases. In patients with isolated intramural disease or proximal small bowel involvement endoscopy may be negative and MRE can help to make diagnosis. Capsule endoscopy can diagnose proximal disease but less sensitive to diagnose stricturing and extraluminal disease.