ORIGINAL ARTICLE: GASTROENTEROLOGY

Magnetic Resonance Enterography Healing and

Magnetic Resonance Enterography Remission Predicts
Improved Outcome in Pediatric Crohn Disease
y
Cary G. Sauer, zJeremy P. Middleton, §Courtney McCracken, yjjJonathan Loewen,
yjj
Kiery Braithwaite, yjjAdina Alazraki, ôDiego R. Martin, and ySubra Kugathasan

ABSTRACT

Background: Mucosal healing predicts clinical remission and improved What Is Known
outcomes in patients with Crohn disease (CD). Magnetic resonance enter-
ography (MRE) is a noninvasive imaging modality that can assess small and  Crohn disease affects the small bowel, often beyond
large bowel wall inflammation. Evidence suggests that MRE may be an
the reach of endoscopy.
acceptable alternative to evaluate mucosal healing over endoscopy. Our  Mucosal healing results in improved outcome in
objective is to determine whether MRE remission predicts clinical remission
Crohn disease.
at follow-up in children with CD.  Magnetic resonance enterography detects active
Methods: We performed an institutional review board–approved
inflammation in Crohn disease.
retrospecitve chart review using our prospectively maintained MRE CD  Magnetic resonance enterography correlates with
database. Inclusion criteria were all children who underwent an MRE more
endoscopy and histopathology.
than 6 months after diagnosis with CD who had follow-up of at least 1 year
from imaging.
Results: A total of 101 children with CD underwent MRE, a median of 1.3 What Is New
years from diagnosis with a median follow-up of 2.8 years after MRE.
 Magnetic resonance enterography remission and
Active inflammation was detected in 65 MRE studies, whereas 36 MRE
studies demonstrated MRE remission. A total of 88.9% of children resolution of active inflammation is associated with
demonstrating MRE remission were in clinical remission at follow-up, fewer surgeries for Crohn disease.
 Magnetic resonance enterography remission is
whereas only 44.6% of those demonstrating MRE active inflammation
achieved clinical remission. Children demonstrating MRE-active associated with fewer medication changes.
 Magnetic resonance enterography may be a surro-
inflammation were more likely to have a change in medication (44.6%
vs 8.3%) and more likely to undergo surgery (18.5% vs 2.8%). gate for mucosal healing, especially when not acces-
Conclusions: MRE remission is associated with clinical remission at sible by standard endoscopy.
follow-up at least 1 year after MRE. MRE remission was associated with
fewer medication changes and fewer surgeries suggesting that, similar to
endoscopic remission, MRE remission demonstrates improved outcome.
Key Words: Crohn disease, magnetic resonance enterography, pediatric
Additional research is needed to confirm that MRE can be used as a surrogate
for mucosal healing.
(JPGN 2016;62: 378–383)

Received January 30, 2015; accepted August 31, 2015.

From the Emory University School of Medicine Department of Pediatrics,
the yChildren’s Healthcare of Atlanta, the zDepartment of Pediatrics,
University of Virginia Health System, the §Division of Bioinformatics,
Emory and Children’s Research Center, Atlanta, GA, the jjDivision of
Pediatric Radiology, Emory University Department of Pediatrics, and the
ôDivision of Radiology, Arizona University School of Medicine,
Tucson.
Address correspondence and reprint requests to Cary G. Sauer, MD, Emory
University School of Medicine, Division of Pediatric Gastroenterology,
Emory Children’s Center, 2015 Uppergate Dr, Atlanta, GA 30322
(e-mail: csauer@emory.edu).
This research was supported by the Crohn’s and Colitis Foundation of
America through a Career Development Award (C.G.S.) and by the
Emory and Children’s Research Institute for Statistical Analysis (C.M.).
The authors report no conflicts of interest.
Copyright # 2016 by European Society for Pediatric Gastroenterology,
Hepatology, and Nutrition and North American Society for Pediatric
Gastroenterology, Hepatology, and Nutrition
DOI: 10.1097/MPG.0000000000000976
C rohn disease (CD) is a chronic inflammatory bowel disease
that can affect all portions of the gastrointestinal tract. CD
diagnosed in childhood has a poor prognosis with up to 59% of
children displaying complicated disease at long-term follow-up (1,2).
Despite medical management, the risk of surgery 3 years after
diagnosis is 20%, and 5 years after diagnosis is 34% (1). Improving
the outcome of pediatric CD is essential in this lifelong disease.
Improved outcome and sustained clinical remission has been
reported in patients who demonstrated endoscopic remission
and mucosal healing, regardless of treatment (3–7). The use of
regular endoscopic surveillance to adjust treatment results in higher
likelihood of obtaining mucosal healing (8). In addition, a recent
evaluation of the Study of Biologic and Immunomodulator Naive
Patients in Crohn’s Disease (SONIC) trial suggests that clinical
symptoms are not a reliable measure of mucosal healing (9). Mucosal
healing as an endpoint of therapy has become the preferred target as a
result of mounting data demonstrating improved outcome.
Endoscopy can be used to detect mucosal healing in the
colon and terminal ileum; however, when small bowel or ileal

378 JPGN  Volume 62, Number 3, March 2016

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 JPGN  Volume 62, Number 3, March 2016 MRE Healing and Remission Predicts Improved Outcome in Pediatric CD
predominant CD is present, endoscopy may not fully evaluate the
disease burden. The use of magnetic resonance imaging and other
cross-sectional imaging techniques to evaluate for mucosal healing
is necessary in many patients. In addition, these techniques do not
require sedation/anesthesia and can detect additional findings such
as intraabdominal complications that endoscopy cannot evaluate.
The utility of small bowel imaging for CD with magnetic
resonance enterography (MRE) has been well established. In
pediatric CD, MRE has been shown to be feasible (10–13), useful
for diagnosis (14,15), and to correlate with endoscopy and histo-
pathology (16–18). MRE can detect response to treatment in as
little as 2 weeks (19,20). Meanwhile, small bowel imaging with
MRE or CT enterography has been shown to be useful in medical
management of CD, and accurate in assessing mucosal healing in
patients with CD when compared with ileocolonoscopy (21–25).
Recently, a comparison of MRE to balloon enteroscopy of the small
bowel demonstrated similar sensitivities for active inflammation
(26).
No studies have evaluated outcome with mucosal healing as
detected by MRE. We sought to evaluate outcome in children with
small bowel CD who underwent MRE and determine whether
healing on MRE resulted in improved outcome.
METHODS
Study Population
A prospectively maintained MRE database for children with
CD at Emory University and Children’s Healthcare of Atlanta was
queried retrospectively. All of the children who underwent MRE
evaluation greater than 180 days after diagnosis and with at least 1
year of follow-up after MRE were included in the study. Each
patient only contributed 1 MRE study for this analysis. All studies
were ordered by the primary gastroenterologist for clinical reasons,
and no MRE studies were performed for research purposes. The
indication for each MRE was most frequently listed as Crohn
disease, and therefore specific symptoms could not be evaluated.
The study was institutional review board approved for the use of
private health information.
Chart Review
A comprehensive chart review was performed to obtain
updated data on physician global assessment (PGA), current medi-
cations, and complications. Patients taking mercaptopurine,
azathioprine, or methotrexate were considered to be on immuno-
modulator therapy whereas those on infliximab or adalimumab
were considered to be on biologic therapy.
All of the MRE studies were evaluated by radiologists with
advanced training in MRE interpretation. One of 3 radiologists
independently reviewed the study and determined whether it fits
into 1 of 2 categories: MRE Remission and MRE-Active Inflam-
mation. Chronic disease changes without active inflammation were
considered remission. MRE remission defined as lack of active
inflammation was considered complete MRE healing.
Our primary outcome measure was set before data collection
as PGA at last follow-up. In addition, we collected data on
medications, medication changes, and surgery but chose before
collection of data to not to include more subjective measures of
disease outcome such as hospitalization or symptom index.
MRE Protocol
Our MRE protocol consists of a combination of T2-weighted,
and dynamic, multiphase contrast-enhanced T1-weighted images
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through the abdomen and pelvis, including the perineum, including
sequences to detect perianal CD. Sedation was not used for any of
the children younger than 6 years (2 patients in this study). All of the
patients were scanned on a 3T (Magnetom Trio Tim; Siemens
Healthcare, Erlangen, Germany) or 1.5T (Magnetom Aera; Siemens
Healthcare) scanner. The protocol is designed such that there
is redundancy among the sequences to allow several opportunities
to assess the same anatomy in multiple planes. T2-weighted images
were acquired in both the axial and coronal planes with a single-shot
fast spin echo (ssT2) sequence (380 mm2 field of view [FOV],
320  224 matrix, 5-mm slice thickness, TR/TE/flip angle ¼ 1500/
70/150, acceleration factor of 2.0) both without fat saturation, and
with fat saturation using spectral adiabatic inversion recovery
technique (27). Axial and coronal 3D T1-weighted gradient echo
(T1W GRE) images were obtained in the precontrast phase, and
then subsequently in the arterial, venous, and delayed phases with
the following parameters: 380 mm2 FOV, 288 matrix (80% phase
resolution), partial Fourier imaging 6/8, TR/TE/flip angle ¼ 3.44/
1.25/10o, 104 slices at 2.8-mm slice thickness, and bandwidth at 450
hertz/pixel and 2 times acceleration. Each patient’s weight was
recorded and gadopentetate dimeglumine (Magnevist; Bayer Scher-
ing Pharma, Berlin, Germany) was administered at a dose of
0.1 mmol/kg and a rate of 2 mL/s, followed by a 20-mL saline
flush at 2 mL/s using a dual chamber power injector (Spectris;
Medrad, Warrendale, PA). Acquisition time for 3D GRE images
was 15 to 17 seconds and performed in a single breath hold. Our
protocol does not use antimotility agents. Patients were imaged in
the supine position. Nonsedated patients also received oral contrast
(450–900 mL Volumen, 60 minutes before imaging), as tolerated.
Additional sequences include diffusion-weighted images, and an
axial steady state free precession sequence was also obtained with a
single-shot technique (380 mm2 FOV, 320  256 matrix, TR/TE/flip
angle ¼ 3.51/1.55/508, 50 slices at 5 mm thickness [no gap], and
bandwidth of 1040 hertz/pixel). A coronal, thick section heavily
T2-weighted sequence (380 mm2 FOV, 384  307 matrix, 60 mm
slice thickness, TR/TE/flip angle ¼ 2000–5000/709/180, accelera-
tion factor of 2.0) is then acquired 15 times (each slab acquisition
between 2 and 5 seconds) to assess the dynamic properties of bowel
motility. Additional T2-weighted sequences were also acquired
through the pelvis with ssT2 sequence in the sagittal plane and a
high-resolution, 3-dimensional (3D) turbo spin echo sequence using
variable flip angles in the axial plane (250 mm2 FOV, 256  257
matrix, 1-mm slice thickness, TR/TE/flip angle ¼ 1300/97/variable,
approximately 5 to 6 minutes acquisition time). When patients were
unable to breath hold or were sedated, an additional motion-
insensitive pre- and postcontrast T1 fast low-angle shot sequence
was added for further review.
MRE Interpretation
One of 3 pediatric radiologists (A.A., K.B., J.L.) with
advanced training in MRE interpretation reviewed each MRE
studies and was blinded to the history and clinical symptoms.
MRE studies were reviewed separate from the original clinical
reading. Comparison between the original reading and the reading
for the present study was not made because the reading for the
present study focused only on the presence or absence of
active inflammation.
Active inflammation was defined as abnormal bowel wall
thickening with corresponding increased enhancement on postga-
dolinium T1W images along with high signal intensity on T2W-
spectral adiabatic inversion recovery technique fat-suppressed
images. Residual abnormal enhancement with improvement
in bowel wall thickening and simultaneous recovery of normal
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TABLE 1. Population characteristics

MRE remission MRE active inflammation P

No. patients 36 65
Sex (%)
Male 20 (55.6) 39 (60.0) NS
Female 16 (44.4) 26 (40.0) NS
Age classification (Paris classification)
A1a (<10 y old) 7 15 NS
A1b (10–17 y old) 29 47 NS
A2 (17–40 y old) 0 3 NS

Disease location (Paris classification) (%)
L1 9 (25.0) 13 (20.0) NS
L2 12 (33.3) 12 (18.5) NS
L3 15 (41.7) 40 (61.5) NS
L4a 7 (19.4) 11 (16.9) NS
L4b 5 (13.9) 20 (30.8) NS
Disease behavior (Paris classification)
B1 (nonstricturing, nonpenetrating) 31 46 NS
B2 (stricturing) 5 13 NS
B3 (penetrating) 0 2 NS
B2B3 (penetrating and stricturing) 0 4 NS
P (perianal modifier) 6 8 NS
Median interval in years from diagnosis to MRE (range) 1.5 (0.5–7.6) 1.3 (0.5–8.4) NS
Median disease duration, y (range) 4.5 (1.7–10.3) 4.9 (1.6–12.0) NS
Median follow-up after MRE, y (range) 2.4 (1.1–5.1) 3.2 (1.0–5.5) NS

MRE ¼ magnetic resonance enterography. L1, distal 1/3 ileum  limited cecal disease; L2, colonic; L3, ileocolonic; L4a, upper disease proximal to
Ligament of Treitz; L4b, upper disease distal to ligament of Treitz and proximal to distal 1/3 ileum.

Percentages do not add to 100% because patients can have multiple locations.

T2 signal was determined to be resolution of the active inflam-
mation but with underlying fibrosis, and thus would be classified as
no active inflammation. Lymph node enlargement, comb sign, and
free fluid were not included in the analysis but may have contributed
to the final interpretation. MRE studies were classified as MRE
remission and MRE active inflammation based on the criteria
above. Active inflammation was classified in an all-or-none
approach and degree of inflammation was not considered.
only CD. CD diagnosis was confirmed based on the presence of a
granuloma, presence of gross endoscopic small bowel disease, and
in the case of colonic only CD by expert review (S.K.). Patient
characteristics including disease location, disease duration, and
duration of follow-up after MRE were no different between
MRE remission and MRE active inflammation groups. Median
interval from diagnosis until the first MRE was 1.3 years and
median follow-up was 2.8 years for our population (Table 1).

Statistical Analysis MRE Results

Statistical analyses were conducted using SAS 9.3 for Win-
dows (SAS Institute, Cary, NC). Statistical significance was
assessed at the 0.05 level. MRE status was defined as a binary
variable (remission, active inflammation). Chi-square tests were
used to compare sex, race, treatment, and PGA at follow-up among
the MRE remission group and the MRE active inflammation group.
For some comparisons, exact chi-square tests were used if the cell
counts were less than 5. In addition, the exact chi-square test was
used to compare treatment among the levels of PGA at follow-up.
The Wilcoxon rank-sum test was used to compare the duration of
disease among the MRE groups.
RESULTS
Demographics and Clinical Characteristics
A total of 101 children underwent MRE evaluation greater
than 180 days after diagnosis with at least 1 year of follow-up after
MRE. Most children in the study demonstrated small bowel disease
on initial diagnostic staging of CD location based on the Paris
classification; however, 24 of 101 (23.8%) demonstrated colonic
MRE studies demonstrated 36 children with CD in MRE
remission and 65 children with CD demonstrated MRE active
inflammation. Figures 1 and 2 illustrate MRE studies classified
as MRE remission and MRE-active inflammation.
Treatment
At the time of MRE study, there were no differences in
medications used (immunomodulators vs biologics) between the
active inflammation and remission groups. Of those taking immu-
nomodulator medications as primary therapy, 10 of 33 (30.3%)
patients demonstrated MRE remission. Of those on biologic medi-
cations as primary therapy, 26 of 68 (38.2%) patients demonstrated
MRE remission (Table 2).
At the time of last follow-up, 3 (8.3%) patients in the MRE
remission group changed medications, whereas 29 (44.6%) children
in the MRE active inflammation group changed medications.
Medication changes included switching from an immunomodulator
to a biologic medication and changing the type of biologic
medication used (Table 2).

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 JPGN  Volume 62, Number 3, March 2016 MRE Healing and Remission Predicts Improved Outcome in Pediatric CD

A B

FIGURE 1. Remission. A, Coronal T2 spectral adiabatic inversion recovery technique (SPAIR) and (B) T1 postcontrast images at the level of the
pelvis show no abnormal within the bowel walls, but with corresponding thin enhancement (arrows) suggesting chronic, fibrous change.

A B

FIGURE 2. Active inflammation. A, Axial T2 spectral adiabatic inversion recovery technique (SPAIR) and (B) T1 postcontrast images at the level of
the pelvis show abnormal bright signal in a thick-walled segment of distal ileum (arrows) with corresponding enhancement.

Clinical Outcome at Follow-up patients, 17 achieved clinical remission by PGA at follow-up,

In children who demonstrated MRE remission (n ¼ 36),
88.9% were in clinical remission at follow-up, with the median
follow-up of 2.4 years. In patients who demonstrated MRE-active
inflammation (n ¼ 65), only 29 (44.6%) were in clinical remis-
sion. Of those patients with active inflammation on MRE, 29
(44.6%) underwent a change of medication and of those 29
5 demonstrated mild disease on PGA at follow-up, 5 demonstrated
moderate disease on PGA at follow-up, and 2 demonstrated severe
disease on PGA at follow-up. In children demonstrating MRE
remission, only 1 (2.8%) underwent surgery during the follow-up
time period, whereas in the MRE active inflammation
group 12 children (18.5%) underwent surgery during the
follow-up period (Table 3).

TABLE 2. Treatment at MRE and long-term follow-up

MRE remission (n ¼ 36) MRE active inflammation (n ¼ 65) P

Treatment at time of MRE (%)

Immunomodulator 10 (27.8) 23 (35.4) 0.435
Biologic 26 (72.2) 42 (64.6)
Treatment at follow-up visit (%)
Immunomodulator 9 (25.0) 7 (10.8) 0.061
Biologic 27 (75.0) 58 (90.9)
Change in medication (%)
Immunomodulator to biologic 1 (2.8) 17 (26.2) 0.003
Biologic change within class 2 (5.6) 12 (18.5) 0.072

MRE ¼ magnetic resonance enterography.

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 Sauer et al
TABLE 3. Long-term follow-up outcome
PGA at long-term follow-up MRE remission (n ¼ 36)
Clinical remission (%) 32 (88.9)
Mild disease (%) 3 (8.3)
Moderate disease (%) 1 (2.8)
Severe disease (%) 0 (0)
Surgery (%) 1 (2.8)
Any change in medication (%) 3 (8.3)
MRE ¼ magnetic resonance enterography; PGA ¼ physician global assessment.
DISCUSSION
Mucosal healing as evaluated by endoscopy is associated
with improved outcome in multiple studies (3,6,7). Conventional
endoscopy, however, is invasive, is limited to the distal ileum, and
requires sedation or anesthesia in children. Data suggest that MRE
can be used to monitor response to treatment, detect active disease
not evident on endoscopy, and demonstrates high correlation with
mucosal healing on endoscopy (20,24). These data suggest that
MRE may be act as a substitute to endoscopy when evaluating for
mucosal healing.
There is a paucity of data regarding outcome after demon-
strating healing on cross-sectional imaging. Our study demonstrates
improved outcome in children with MRE remission as compared to
those with active inflammation on MRE. Children achieving MRE
remission were less likely to have a change in medication or need
for surgery and more likely to be in clinical remission at long-term
follow-up. There was 1 patient in the MRE remission who went on
to require surgery after developed a small bowel obstruction
because of a stricture after he lost response to his primary medi-
cation. MRE remission was defined as absence of active inflam-
mation on MRE and can be considered similar to mucosal healing
on endoscopy. The present study further supports emerging data
that objective findings of remission by endoscopy or imaging are
associated with improved outcome (6,8).
One of the advantages of MRE is evaluating proximal small
bowel CD. In our study, more than 40% of our patients had Paris
classification L4a or L4b. Because demonstrating mucosal healing
in these patients would require small bowel enteroscopy, the use of
serial imaging in lieu of endoscopy would be preferable as this is an
advanced endoscopic procedure not available at all pediatric cen-
ters. Knowing that MRE can demonstrate mucosal healing is critical
in making treatment decisions in children with extensive small
bowel disease.
A total of 44% of children demonstrating MRE-active
inflammation obtained clinical remission at follow-up with medi-
cation changes, whereas another 30% demonstrated only mild
disease activity. Data suggest that mucosal healing by endoscopy
can be obtained in approximately 60% of patients with aggressive
disease monitoring and adjusting of medications (8). Our data
support the present data that adjustment in management after
objective findings of active disease can result in remission. We
did not repeat MRE studies to confirm MRE remission in these
patients obtaining clinical remission. Future studies may demon-
strate more frequent use of MRE and/or endoscopy to monitor
pediatric CD will result in even higher likelihood of clinical,
endoscopic, and/or MRE remission.
There are several limitations to our study. All MRE studies
were performed as part of patient care at the discretion of the
primary gastroenterologist and thus were likely to be sympto-
matic. Therefore, our population is skewed to those with
382
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JPGN  Volume 62, Number 3, March 2016
MRE active inflammation (n ¼ 65) P
29 (44.6) <0.001
20 (30.8)
11 (16.9)
5 (7.7)
12 (18.5) 0.024
29 (44.6) <0.001
continued symptoms and those not responding to their current
treatment, evident by a high percentage with active inflammation.
The present use of cross-sectional imaging, however, provides a
window into its use in clinical practice. Indication for MRE was
available but in a vast majority the indication was Crohn disease
and therefore was not useful to analysis regarding symptoms or no
symptoms. We did not use a standardized MRE scoring system for
our studies but instead deployed an ‘‘all or none’’ approach as did
previous studies evaluating endoscopic healing. We believed this
manner of grading MRE studies was more akin to grading
endoscopic remission where a Simple Endoscopic Score for
CD must be 0 to be considered mucosal healing. Because most
MRE scoring systems are difficult to use a recent study demon-
strates that T2 hyperintensity was the best marker for active
disease (28). We also chose not to include less objective measures
of outcome such as hospitalization or flares as criteria for
hospitalization and definition of flares can differ greatly. Finally,
we did not perform repeat MRE studies or endoscopy at the end of
follow-up because performing these studies on asymptomatic
children can be difficult to justify.
In summary, we demonstrate superior outcome in children
with CD who demonstrate MRE remission. Children with CD who
demonstrate MRE remission were less likely to change medi-
cations, less likely to require surgery, and were more likely to
be in clinical remission at follow-up. The present data suggest that
demonstrating healing with MRE may be an effective alternative to
endoscopy, and should be considered when lesions are beyond the
reach of standard endoscopy. More prospective studies in children
are necessary to determine whether MRE can be used as a surrogate
to endoscopy in evaluating mucosal healing.
REFERENCES
1. Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of
pediatric Crohn’s disease: a population-based cohort study. Gastroen-
terology 2008;135:1106–13.
2. Van Limbergen J, Russell RK, Drummond HE, et al. Definition of
phenotypic characteristics of childhood-onset inflammatory bowel dis-
ease. Gastroenterology 2008;135:1114–22.
3. af Bjorkesten CG, Nieminen U, Sipponen T, et al. Mucosal healing at 3
months predicts long-term endoscopic remission in anti-TNF-treated
luminal Crohn’s disease. Scand J Gastroenterol 2013;48:543–51.
4. Sakuraba A, Annunziata ML, Cohen RD, et al. Mucosal healing is
associated with improved long-term outcome of maintenance therapy
with natalizumab in Crohn’s disease. Inflamm Bowel Dis 2013;19:
2577–83.
5. Beppu T, Ono Y, Matsui T, et al. Mucosal healing of ileal lesions is
associated with long-term clinical remission after infliximab mainte-
nance treatment in patients with Crohn’s disease. Dig Endosc
2015;27:73–81.
6. Baert F, Moortgat L, Van Assche G, et al. Mucosal healing predicts
sustained clinical remission in patients with early-stage Crohn’s disease.
Gastroenterology 2010;138:463–8.
www.jpgn.org
 JPGN  Volume 62, Number 3, March 2016 MRE Healing and Remission Predicts Improved Outcome in Pediatric CD
7. Schnitzler F, Fidder H, Ferrante M, et al. Mucosal healing predicts long-
term outcome of maintenance therapy with infliximab in Crohn’s
disease. Inflamm Bowel Dis 2009;15:1295–301.
8. Bouguen G, Levesque BG, Pola S, et al. Endoscopic assessment and
treating to target increase the likelihood of mucosal healing in patients
with Crohn’s disease. Clin Gastroenterol Hepatol 2014;12:978–85.
9. Ferrante M, Colombel JF, Sandborn WJ, et al. Validation of endoscopic
activity scores in patients with Crohn’s disease based on a post
hoc analysis of data from SONIC. Gastroenterology 2013;145:978–
86e5.
10. Courtier J, Cardenas A, Tan C, et al. Nonanesthesia magnetic resonance
enterography in young children: feasibility, technique, and performance.
J Pediatr Gastroenterol Nutr 2015;60:754–61.
11. Dagia C, Ditchfield M, Kean M, et al. Feasibility of 3-T MRI for
the evaluation of Crohn disease in children. Pediatr Radiol 2010;
40:1615–24.
12. Silverstein J, Grand D, Kawatu D, et al. Feasibility of using MR
enterography (MRE) for the assessment of terminal ileitis and inflam-
matory activity in children with Crohn disease (CD). J Pediatr Gastro-
enterol Nutr 2012;18:173–7.
13. Absah I, Bruining DH, Matsumoto JM, et al. MR enterography in
pediatric inflammatory bowel disease: retrospective assessment of
patient tolerance, image quality, and initial performance estimates.
AJR Am J Roentgenol 2012;199:W367–75.
14. Darbari A, Sena L, Argani P, et al. Gadolinium-enhanced magnetic
resonance imaging: a useful radiological tool in diagnosing pediatric
IBD. Inflamm Bowel Dis 2004;10:67–72.
15. Horsthuis K, de Ridder L, Smets AM, et al. Magnetic resonance
enterography for suspected inflammatory bowel disease in a pediatric
population. J Pediatr Gastroenterol Nutr 2010;51:603–9.
16. Dillman JR, Ladino-Torres MF, Adler J, et al. Comparison of MR
enterography and histopathology in the evaluation of pediatric Crohn
disease. Pediatr Radiol 2011;41:1552–8.
17. Sauer CG, Middleton JP, Alazraki A, et al. Comparison of magnetic
resonance enterography (MRE) to endoscopy, histopathology and la-
boratory evaluation in pediatric Crohn disease. J Pediatr Gastroenterol
Nutr 2012;55:178–84.
www.jpgn.org
Copyright 2016 by ESPGHAN and NASPGHAN. Unauthorized reproduction of this article is prohibited.
18. Maccioni F, Ansari NA, Mazzamurro F, et al. Detection of Crohn disease
lesions of the small and large bowel in pediatric patients: diagnostic
value of MR enterography versus reference examinations. AJR Am J
Roentgenol 2014;203:W533–42.
19. Van Assche G, Herrmann KA, Louis E, et al. Effects of infliximab
therapy on transmural lesions as assessed by magnetic resonance
enteroclysis in patients with ileal Crohn’s disease. J Crohns Colitis
2013;7:950–7.
20. Ordas I, Rimola J, Rodriguez S, et al. Accuracy of magnetic resonance
enterography in assessing response to therapy and mucosal healing in
patients with Crohn’s disease. Gastroenterology 2014;146:374–82e1.
21. Leyendecker JR, Bloomfeld RS, DiSantis DJ, et al. MR enterography in
the management of patients with Crohn disease. Radiographics
2009;29:1827–46.
22. Martin DR, Kalb B, Sauer CG, et al. Magnetic resonance enterography
in Crohn’s disease: techniques, interpretation, and utilization for clinical
management. Diagn Interv Radiol 2012;18:374–86.
23. Sanka S, Gomez A, Set P, et al. Use of small bowel MRI enteroclysis in
the management of paediatric IBD. J Crohns Colitis 2012;6:550–6.
24. Patel NS, Pola S, Muralimohan R, et al. Outcomes of computed
tomography and magnetic resonance enterography in clinical practice
of inflammatory bowel disease. Dig Dis Sci 2014;59:838–49.
25. Qiu Y, Mao R, Chen BL, et al. Systematic review with meta-analysis:
magnetic resonance enterography vs. computed tomography enterogra-
phy for evaluating disease activity in small bowel Crohn’s disease.
Aliment Pharmacol Ther 2014;40:134–46.
26. Takenaka K, Ohtsuka K, Kitazume Y, et al. Comparison of magnetic
resonance and balloon enteroscopic examination of the small intestine
in patients with Crohn’s disease. Gastroenterology 2014;147:334–42e3.
27. Udayasankar UK, Martin D, Lauenstein T, et al. Role of spectral
presaturation attenuated inversion-recovery fat-suppressed T2-weighted
MR imaging in active inflammatory bowel disease. J Magn Reson
Imaging 2008;28:1133–40.
28. Quaia E, Cabibbo B, Sozzi M, et al. Biochemical markers and MR
imaging findings as predictors of Crohn disease activity in patients
scanned by contrast-enhanced MR enterography. Acad Radiol
2014;21:1225–32.
383