Quantified small bowel motility assessment on magnetic resonance enterography in paediatric inflammatory bowel disease - does it reflect clinical response?

Riwa Meshaka; Heather E Fitzke; Joy Barber; Kelsey Jones; Stuart A Taylor; Tom A Watson

doi:10.1007/s00247-024-06097-y

Quantified small bowel motility assessment on magnetic resonance enterography in paediatric inflammatory bowel disease - does it reflect clinical response?

Pediatr Radiol. 2024 Nov 19. doi: 10.1007/s00247-024-06097-y. Online ahead of print.

Authors

Riwa Meshaka¹, Heather E Fitzke², Joy Barber³, Kelsey Jones⁴, Stuart A Taylor², Tom A Watson⁴

Affiliations

¹ Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK. riwa.meshaka@gosh.nhs.uk.
² University College London, London, UK.
³ St George's University Hospitals NHS Foundation Trust, London, UK.
⁴ Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1H 3JH, UK.

PMID: 39560731
DOI: 10.1007/s00247-024-06097-y

Abstract

Background: Quantified small bowel motility assessment using cine magnetic resonance enterography (MRE) has shown promise as a biomarker in adult inflammatory bowel disease. Whether quantified motility corresponds to treatment response in paediatric inflammatory bowel disease is unknown.

Objective: To test whether changes in motility reflect response.

Materials and methods: Local ethics approval was granted for this single-institution, retrospective study. All children < 18 years with confirmed inflammatory bowel disease, who had more than one MRE between Jan 2011-Jan 2022, were included. Simplified MaRIA (sMaRIA) and motility index (quantified motility) at all terminal ileum and diseased non-terminal ileum segments were independently assessed by two radiologists each with ≥ 9 years' experience. Change in (Δ) motility index was compared to clinical (gastroenterologist physician's global assessment) and consensus radiological reference standard (response = decrease in sMaRIA of more than or equal to 2 points) in responders versus non-responders using the Mann-Whitney test. Sensitivity and specificity of Δ motility index more than zero were compared to decrease in sMaRIA of 2 or more points for identifying clinical response.

Results: Of 64 children aged 5-16, 21 out of 64 (33%) were responders, 37 out of 64 (58%) were non-responders and 6 out of 64 (9%) had inactive disease according to clinical reference standard. Δ Motility index by both radiologists was higher in responders (+ 16, + 39) than non-responders (-43, -44), P = 0.04, P = 0.01 each radiologist, respectively. Motility index was more sensitive (57% versus 24%), but less specific (67% versus 93%) than sMaRIA in identifying clinical response.

Conclusion: Motility index on cine MRE corresponds to clinical response, and is more sensitive at detecting response compared to sMaRIA in paediatric inflammatory bowel disease.

Keywords: Crohn’s disease; Gastrointestinal motility; Inflammatory bowel disease; Magnetic resonance imaging (cine); Paediatrics.

Abstract

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