DOP079 The impact of integrating pelvic MRI at diagnosis on early detection of perianal Crohn's disease in pediatrics
Bibliographic record
Abstract
Abstract Background Perianal Crohn’s disease (CD) can be a severe manifestation of pediatric CD.1,2 It is underrecognized, particularly if asymptomatic, with varied reported incidences (10-60%). Earlier detection by pelvic magnetic resonance imaging (pMR) may alter outcomes.3 The aim of this study was to determine if performing pMR on newly diagnosed pediatric CD patients identifies asymptomatic perianal CD and leads to earlier biologic use and less surgery. Methods New CD patients were prospectively enrolled into the Edmonton Pediatric Inflammatory Bowel Disease Clinic (EPIC) registry; EPIC has done baseline pMR since 2018. A retrospective review (2018-2023) collected pMR, perianal exam, symptoms, blood work, calprotectin, medication, and surgery (luminal and/or perianal) data. A blinded radiologist read pMRs using St. James and Parks criteria. Statistics included descriptive, Fisher’s exact test, multivariable logistic regression, and survival analysis. Results 139 patients were included (63% male, median age 13 [IQR 11-16]). Ninety-six patients (69%) had no pMR perianal disease (pMR-), despite 13/96 (14%) having perianal symptoms and 26/96 (27%) with inflamed (n=6) or non-inflamed (n=14) tags or fissures (n=6). Of the 43 (31%) with pMR+ perianal disease, 27/43 (63%) were asymptomatic (ASx) and 17/43 (40%) had a normal exam. pMR+/ASx patients had physical exam findings that included inflamed (n=4) or non-inflamed (n=5) tags, fissures (n=1), and draining fistula (n=1). Compared to pMR-/ASx, pMR+/ASx patients had a relative risk of 1.40 [95% CI 1.18-1.68] and 1.32 [95% CI 1.17-1.52] of starting a biologic at 6 and 12 months, respectively. For those on biologics for initial maintenance therapy, less anti-TNF was used for pMR+/ASx (n=16/21, 76% of patients on biologics) vs. pMR+/Sx (n=14/14, 100% of patients on biologics). pMR+/Sx needed the most and earlier perianal surgery, but pMR+/ASx also had higher rates and faster time to perianal surgery than pMR-/ASx (p=0.02, Figure 1). Perianal side branch fistula was a significant predictor of perianal surgery (OR 107.6, [95% CI 16.9-2178] p<0.0001). Conclusion The majority of pediatric patients with perianal CD identified on pMR had no perianal symptoms and a normal exam. Even with perianal disease being subclinical, these patients needed more and earlier perianal surgery compared to those with negative pMR. Furthermore, side branch fistula on imaging was a significant predictor of needing perianal surgery. Baseline imaging was also helpful for demonstrating the absence of deeper perianal disease in a quarter of patients who did have perianal symptoms and tags/fissures. References 1.Atia O, Asayag N, Focht G, et al. Perianal Crohn’s Disease Is Associated With Poor Disease Outcome: A Nationwide Study From the epiIIRN Cohort. Clin Gastroenterol Hepatol. 2022;20(3):e484-e495. doi:10.1016/j.cgh.2021.04.007 2.de Zoeten EF, Pasternak BA, Mattei P, Kramer RE, Kader HA. Diagnosis and treatment of perianal Crohn disease: NASPGHAN clinical report and consensus statement. J Pediatr Gastroenterol Nutr. 2013;57(3):401-412. doi:10.1097/MPG.0b013e3182a025ee 3.Chidi VN, Schwartz DA. Imaging of perianal fistulizing Crohn's disease. Expert Rev Gastroenterol Hepatol. 2015;9(6):797-806. doi:10.1586/17474124.2015.1031110
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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".