Magnetic resonance enterography in adolescents and young adults with crohn's disease
Notice bibliographique
Résumé
Introduction MRE has been increasingly used for evaluation of known and suspected Crohn's disease patients but variable availability and high cost remains a problem in some areas. Young patients with Crohn's disease are reported to be particularly at higher risk of receiving high doses of radiation. There is limited data on the use of MRE in this group. The authors aimed to asses the effectiveness of use of MRE in adolescents and young adults based on select criteria used in our institution. Methods Patients with known Crohn's disease diagnosed between 10 and 30 years undergoing MRE during a 2-year period were included. All had full endoscopic assessment and were classified based on Montreal classification. Demographics and clinical parameters were recorded. Actual radiation exposure in DAP (Dose Area Product) and milliseverts (mSv) recorded in RadCentre during procedure of all relevant radiological investigations procedures before and after MRE was calculated. Clinician recorded Montreal classification 3 months before MRE and post-MRE was recorded in relation to changes to classification in extent (L) and disease behaviour (B). Any change to management within 3 months following MRE was noted. Results 31 patients were included in analysis. Male to female ratio was 1:2. Mean age at diagnosis of Crohn's disease was 17.9 years and at the point of MRE scan was 21.25 years. The mean duration of Crohn's disease follow-up pre-MRE was 2.6 years and post-MRE was 1.28 years. The indications included obstructive symptoms (n=14, 45.1%), assessment of extent (n=15, 48.3%), suspicion of internal fistula (n=1, 3.2%) and non-responsiveness to therapy (n=1, 3.2%). The findings included small bowel stricture (20), stricture with associated abscess (3), colonic stricture (n=2), thickening (3), fistula (1) and gastric outlet obstruction (1). In 6 patients the MRE was normal. Following MRE 16 patients (51.6%) had upgrading of disease behaviour (B) and 3 of them also had additional disease location (L). In 4 patients the MRE identified longer length of small bowel involvement than recorded before. The average radiation exposure pre-MRE was 7.47 mSv and post-MRE was 1.56 mSv. In 4 patients the planned management was modified due to additional findings in MRE result. Conclusion This study describes our experience in the use of MRE in a high risk group of adolescent and young adults with Crohn's disease. Application of specific referral criteria and patient selection may increase pick up rate, improve clinical utility by altering disease classification and extent, reduce radiation exposure and potentially reduce costs. Longer follow-up of a larger cohort of patients following introduction of MRE in a hospital is needed to confirm reduction in radiation exposure in this group.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».