Magnetic resonance enterography in adolescents and young adults with crohn's disease
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".