A180 THE IMPACT OF INTEGRATING PELVIC MRI AT DIAGNOSIS FOR EARLY DETECTION OF PERIANAL CROHN’S DISEASE IN PEDIATRICS
Bibliographic record
Abstract
Abstract Background Perianal Crohn’s disease (CD) can be a severe, refractory manifestation of pediatric CD. It is underrecognized, particularly if asymptomatic, which has led to varied reported incidences (10-60%). Earlier detection by pelvic magnetic resonance imaging (pMR) may alter management and outcomes. Aims If performing pMR on newly diagnosed pediatric CD patients identifies asymptomatic perianal CD and leads to earlier biologic use, fewer hospitalizations, and less surgery. Methods New CD patients were prospectively enrolled into the Edmonton Pediatric Inflammatory Bowel Disease Clinic (EPIC) registry. This clinic has done baseline pMR since 2018. A retrospective review (2018-2023) collected pMR, perianal exam, symptoms, blood work, calprotectin, medications, and surgeries (perianal and intestinal). A blinded radiologist re-read pMRs using St. James and Parks criteria. Statistics included descriptive, Fisher’s exact test, multivariate 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)/ 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 with perianal exam findings included inflamed (n=4)/ non-inflamed (n=5) tags, fissures (n=1), and draining fistula (n=1). pMR+/Sx had higher Parks and St James scores compared to pMR+/ASx. Compared to pMR-, pMR+/ASx and pMR+/Sx patients had a relative risk of 1.40 [95% CI 1.16-1.71] and 1.72 [95% CI 1.72-1.73] of requiring a biologic at 6 months, and a relative risk of 1.39 [95% CI 1.23-1.62] and 1.45 [95% CI 1.45-1.46] of requiring a biologic at 1 year. pMR+/Sx patients had an increased probability of CD surgery (p<0.002) but not hospitalization (p>0.05). There were no differences between pMR+/ASx and pMR- patients in surgery or hospitalization (p>0.05). Time to surgery was shorter in pMR+/Sx (p<0.01), but not different between pMR+/ASx and pMR- (p>0.05). Conclusions The majority of patients with perianal CD identified on pMR had no perianal symptoms and had a normal exam. This early identification of subclinical perianal disease led to increased and earlier biologic use, which may explain the lack of increased hospitalization and surgical rates compared to those without pMR+ perianal disease. Baseline imaging was also helpful for demonstrating the absence of deeper perianal disease in several patients who did have perianal symptoms and tags/fissures. Funding Agencies NACTRC, Stollery Children’s Hospital Foundation through WCHRI
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".