ORIGINAL RESEARCH Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn’s Disease Katrina F. Chu, MD, 1 Christopher J. Moran, MD, 2 Kaiming Wu, MD, 1 Jess L. Kaplan, MD, 2 Jeffrey R. Savarino, BS, 2 Tamsin Board, BS, 2 Esther J. Israel, MD, 2 Harland S. Winter, MD, 2 and Michael S. Gee, MD, PhD 1 * Background: MR enterography (MRE) is the primary modality for evaluating small bowel disease in pediatric Crohn’s patients. Standard clinical practice includes imaging patients at diagnosis and during symptomatic recurrence. The role for MRE in surveillance of asymptomatic Crohn’s patients has not yet been established. Purpose: To determine whether MRE imaging features are associated with clinical recurrence. Study Type: Retrospective. Populations: Pediatric Crohn’s patients who underwent MRE while asymptomatic, defined by pediatric gastroenterologists using a physician global assessment; 35 MREs were identified. Field Strength/Sequence: 1.5T including T 2 -weighted single-shot fast spin echo, balanced steady-state free precession, diffusion-weighted, and contrast-enhanced multiphase T 1 -weighted gradient recalled echo sequences. Assessment: MREs were reviewed by three radiologists independently for mural thickening, T 2 -weighted hyperintensity, diffusion restriction, hyperenhancement, vasa recta engorgement, and overall assessment of disease activity. Two pediatric gastroenterologists reviewed patient medical records for 6 months following MRE to evaluate for recurrence, defined as Crohn’s-related treatment escalation, surgery, or hospitalization. Statistical Tests: Fisher’s exact test, Wald chi-square test, and model selection by Akaike information criterion minimiza- tion were used to assess statistical significance of MRE imaging features. Results: Of 35 MREs identified, seven cases demonstrated clinical recurrence at 6 months (20%); 28 cases remained in remission (80%). Imaging features of active disease were present in 86% of patients with recurrence compared to 29% of patients in remission (P = 0.01). Wall thickening, T 2 -weighted hyperintensity, hyperenhancement, and diffusion restriction were significantly associated with recurrence. Multivariate regression analysis determined diffusion restriction to be the best predictor of recurrence within 6 months (P = 0.001, area under the curve 0.786). Data Conclusion: MRE performed on young asymptomatic Crohn’s patients can identify patients who have a high probability of developing clinical recurrence in a 6-month period, indicating a potential role for surveillance imaging to assess for subclini- cal active disease. Level of Evidence: 3 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2019. C ROHN’S DISEASE (CD) is a chronic inflammatory bowel disease (IBD) characterized by transmural inflam- mation of one or more segments of the gastrointestinal tract. The growing incidence and prevalence of pediatric CD over the last few decades have been documented in several epide- miologic studies, 1–3 with an estimated 20–30% of patients diagnosed with CD before the age of 18 years. 4,5 Patients typically have a chronic relapsing and remitting course, with View this article online at wileyonlinelibrary.com. DOI: 10.1002/jmri.26811 Received Jan 31, 2019, Accepted for publication May 15, 2019. *Address reprint requests to: M.S.G., Division of Pediatric Radiology, Massachusetts General Hospital, 55 Fruit St., Ellison 237, Boston, MA 02114. E-mail: msgee@partners.org From the 1 Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA; and 2 Department of Pediatric Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA © 2019 International Society for Magnetic Resonance in Medicine 1