Hepatobiliary and pancreatic findings on magnetic resonance enterography examinations in children with newly diagnosed inflammatory bowel disease.

backgroundSome children with inflammatory bowel disease (IBD) have hepatobiliary and/or pancreatic manifestations of the disease. The frequency of related imaging abnormalities at IBD diagnosis is unknown.

objectiveTo identify and quantify hepatobiliary and pancreatic findings on baseline magnetic resonance enterography (MRE) examinations in children with newly diagnosed IBD. MATERIALS AND

methodsChildren <18 years of age diagnosed with IBD between August 2022 and April 2024 who underwent MRE within 90 days of diagnosis were included. Three radiologists retrospectively reviewed the MREs, reported the presence of intrahepatic biliary dilation, and measured maximum extrahepatic bile and pancreatic duct diameters and pancreas:spleen T1 signal intensity ratios (SIR). Pancreatic volume was calculated from axial T2 images using an open-source segmentation tool (PaNSegNet).

resultsA total of 111 children were included: 77% (n=86) with Crohn disease; 22% (n=24) with ulcerative colitis; 1% (n=1) with IBD-unspecified. The mean age at diagnosis was 13.7 years (range, 5.3-17.9 years); 61% (n=43) were male. Subjective intrahepatic biliary dilation by reviewer consensus was present in 11% (n=12). Extrahepatic biliary dilation was present in 6% (n=7). Pancreatic duct dilation was present in 2% (n=2). Low pancreas:spleen T1 SIR (<1.4 at 1.5 T, <1.3 at 3 T) was present in 14% (n=16). Pancreatic volume was <5th percentile in 6% (n=5) and >95th percentile in 13% (n=14).

conclusionsImaging findings potentially associated with autoimmune-related hepatobiliary or pancreatic disease are present in 2-14% on baseline MR enterography examinations in children with newly diagnosed inflammatory bowel disease. While infrequent, radiologists should be attentive to these findings of multisystem disease.