Magnetic resonance enterography in pediatric celiac disease

Gonca Koc, Selim Doganay, Eylem Sevinc, Kemal Deniz, Govind Chavhan, Sureyya B. Gorkem, Neslihan Karacabey, Mehmet S. Dogan, Abdulhakim Coskun, Duran Aslan

To assess if magnetic resonance enterography (MRE) is capable of showing evidence/extent of disease in pediatric patients with biopsy-proven celiac disease (CD) by comparing with a control group, and to correlate the MRE findings with anti-endomysial antibody (EMA) level, which is an indicator of gluten-free dietary compliance. Thirty-one pediatric patients (mean age 11.7±3.1 years) with biopsy-proven CD and 40 pediatric patients as a control group were recruited in the study. The MRE images of both patients with CD and those of the control group were evaluated by two pediatric radiologists in a blinded manner for the mucosal pattern, presence of wall thickening, luminal distention of the small bowel, and extra-intestinal findings. Patient charts were reviewed to note clinical features and laboratory findings. The histopathologic review of the duodenal biopsies was re-conducted. The mean duration of the disease was 5.6±1.8 years (range: 3-7.2 years). In 24 (77%) of the patients, EMA levels were elevated (mean 119.2±66.6RU/mL). MRE revealed normal fold pattern in all the patients. Ten (32%) patients had enlarged mesenteric lymph nodes. Although a majority of the patients had elevated EMA levels indicating poor dietary compliance, MRE did not show any mucosal abnormality associated with the inability of MRE to detect mild/early changes of CD in children. Therefore, it may not be useful for the follow-up of pediatric CD.