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Pediatric Crohn's disease (CD) often involves the small bowel, which is assessed with imaging techniques; however, validated and standardized metrics for the assessment of the entire small bowel in children is lacking.

In a recent prospective multicenter study published in , investigators aimed to develop and validate an index to evaluate the degree of transmural inflammation in children with CD called the Pediatric Inflammatory Crohn's Magnetic Resonance Enterography (MRE) Index (PICMI).

This index was developed using a large cohort of 240 children across 22 sites, as well as a Delphi panel, a systematic literature review, two ancillary studies, and a steering committee. The final PICMI includes wall thickness, ulceration, wall-restricted diffusion, mesenteric edema, and comb sign as components to the weighted segmental subscore that is then combined to a total PICMI score. The weighted PICMI correlated well with radiologist global assessment and simple endoscopic scoring in the validation cohort. It also had good interobserver and test-retest reliability, as well as good responsiveness at repeated visits.

Clinically, the PICMI is a promising tool for reliably assessing the degree of transmural inflammation in pediatric patients with CD both cross-sectionally and longitudinally. It may also improve the evaluation of disease activity in areas where endoscopy cannot reach. This ultimately will help to improve long-term outcomes of patients with inflammatory bowel disease. Further studies are needed to compare MRE findings in different sites and settings.

Wenly Ruan, MD, is a clinical instructor in the division of pediatric gastroenterology, hepatology, and nutrition at Baylor College of Medicine in Houston, Texas.

You can read an interview with the lead study author here, and the abstract of the study here.