Application Of MEGS In Quantitative Assessment Of Activity Grade Of Crohn’s Disease In Children

Objective: To quantitatively evaluate the value of magnetic resonance enterography global score(MEGS)in the assessment of activity grade in children with Crohn’s disease,so as to improve the accuracy of grading diagnosis of disease severity in children with CD.Materials and Methods: Sixty-four juvenile patients with clinical and pathological diagnosed CD from January 2016 to December 2020 were enrolled.All patients underwent magnetic resonance enterography(MRE)and colonoscopy within 1week.The Montreal disease location classification and disease behavior of the patients were recorded.The most severe lesions of the terminal ileum were scored according to the simplified endoscopic activity score for Crohn’s disease(SES-CD)and MEGS scoring criteria,and the activity of the intestinal segment was divided into 3 groups: remission,mild activity and moderate to severe activity.Mc Nemar test was used to evaluate the differences in the sensitivity and specificity between MEGS and SES-CD in detecting activity lesions in children.The correlation between SES-CD and MEGS was assessed by spearman rank estimation.Using the SES-CD as the reference standard,the differences in MEGS among three groups with different activity were analyzed by Kruskal-Wallis test.The effectiveness of MEGS in diagnosing CD activity was evaluated using the area under the receiver operating characteristic(ROC)curve.Results: According to the montreal classification of disease location,the intestinal segment involvement rate of children with CD was 85.9%(55/64)for ileocolonic,9.4%(6/64)for terminal ileum,and 4.7%(3/64)for colonic.The upper gastrointestinal tract and perianal involvement(including anal fistula and perianal abscess)rates were 40.6%(26/64)and 51.6%(33/64),respectively.In terms of disease behavior,the incidence of non-stricturing and non-penetrating was 73.4%(47/64),stricturing was 21.9%(14/64),and penetrating inflammation was 4.7%(3/64).The score of SES-CD in the terminal ileum of 64 children ranged from 0 to12,with an average(5.4±3.2)score,among which 18 cases were in remission and26 cases were in mild activity and 20 cases were in moderate to severe activity.Correspondingly,the mean MEGS was(8.9±3.4)with a range of 0-16,of which 15 for remission,24 for mild activity and 25 for moderate-to-severe activity.There was no significant difference between MEGS and SES-CD in the assessment of CD activity lesions in children(P>0.05).The SES-CD of 64 intestinal segments showed strong correlation with MEGS(r=0.87,P<0.001).Using the SES-CD as the reference standard,there were significant differences in MEGS among three groups(all P<0.01).The area under the ROC curve(AUC)of MEGS was 0.86 and0.80 for differentiating remission from active and mild from moderate-severe active lesions,respectively.Conclusions: MEGS can accurately and quantitatively evaluate the activity of lesions in the terminal ileum of children with CD and has a strong correlation with SES-CD,which is expected to become the preferred alternative in the clinical activity assessment for treatment follow-up of children with CD.