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The newspaper of The Johns Hopkins University March 22, 2004 | Vol. 33 No. 27
MRI May Help Pediatricians Diagnose Ulcerative Colitis, Crohn's

Magnetic resonance imaging, coupled with the use of the contrast dye gadolinium, may help pediatricians better diagnose children with ulcerative colitis and Crohn's disease, according to a study by researchers at the Johns Hopkins Children's Center.

Results of the study, published in the March issue of Inflammatory Bowel Diseases, showed that the gadolinium-enhanced MRII, or G-MRI, confirmed these diagnoses in more than 90 percent of the children in the study who had inflammatory bowel disease. Because ulcerative colitis and Crohn's disease — two painful ailments with similar origins and symptoms — have two very different treatment regimens, especially if surgical treatment is contemplated, early diagnosis is critical, the researchers say.

"For the most severe cases of ulcerative colitis, surgical removal of the colon is the only cure, while there is no cure for Crohn's disease," says Anil Darbari, a pediatric gastroenterologist at the Children's Center and the lead author of the study. "Unfortunately, many children who are originally diagnosed with ulcerative colitis and have their diseased colon surgically removed are later found to actually have had Crohn's, which is discovered when the disease resurfaces in another area within the intestinal tract.

"We also found that G-MRI was very helpful in diagnosing pediatric small bowel disease, or IBD, which occurs in an area in a child's body that is not accessible by conventional endoscopies or colonoscopies," Darbari said. "Because children with small bowel disease may not exhibit traditional Crohn's disease symptoms, finding definitive evidence of small bowel disease, which is affiliated with Crohn's disease, prevents these children from being labeled with indeterminate IBD and allows them to begin the appropriate drug treatment right away."

Previous studies have shown G-MRI is effective in distinguishing Crohn's disease and ulcerative colitis in adults. However, this is believed to be the first study to establish G-MRI as a radiological tool in diagnosing IBD in children.

In the study, pediatric radiologists at the Johns Hopkins Children's Center performed a G-MRI on 58 children with suspected IBD between 1999 and 2002. Researchers used intravenous gadolinium — a safe, commonly used contrast dye — and other standard imaging tools to enhance the image of the intestinal wall.

Based on G-MRI results, 30 children were classified as having Crohn's disease, eight with ulcerative colitis, six with possible Crohn's disease and 14 as having neither disease. Researchers compared these findings with those from more traditional IBD diagnostic tests, including colonoscopy, in which a tiny scope is inserted through the rectum to examine the lower digestive tract; computerized tomography, which creates a 3-D image of the intestines; small bowel image studies; and biopsied colon tissue. They discovered G-MRI confirmed the diagnosis of ulcerative colitis in 92 percent of patients and the diagnosis of Crohn's disease in 96 percent of patients.

G-MRI is unlikely to replace colonoscopy, Darbari said, because colonoscopy allows tissue samples to be obtained and biopsied for further evaluation. However, he added, for children with suspected small bowel disease, G-MRI does provide a more sensitive, noninvasive diagnostic tool and could replace conventional computerized tomography and small bowel contrast studies.

Crohn's disease and ulcerative colitis primarily affect the intestines, resulting in pain, severe diarrhea, intestinal bleeding, weight loss and fever. Symptoms vary in severity and duration; some patients suffer from frequent prolonged attacks, and others have fewer recurrences. Both diseases usually start in adolescence or young adulthood but can also be seen in younger children. In ulcerative colitis, the inner lining of the colon is inflamed. People with Crohn's disease have similar inflammation, but it extends deeper into the intestinal wall and also can involve the small and large intestines.

The study was supported in part by the Crohn's and Colitis Foundation of America First Award and the Thomas Wilson Sanitarium Awards. Co-authors of the study were Laureen Sena and Carmen Cuffari, both of the Johns Hopkins Children's Center; and Richard Thompson, of the Johns Hopkins School of Public Health.
— Jessica Collins


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