Abstract Objectives We aimed at identifying magnetic resonance enterography (MRE) predictors of surgical intervention and anti‐tumor necrosis factor alpha (TNF‐α) initiation in a paediatric cohort of patients newly diagnosed with isolated ileocaecal (L1) Crohn's disease (CD). Methods A longitudinal retrospective study was conducted at two Italian paediatric referral centres (‘Meyer Children's Hospital’, Florence and ‘Maggiore Hospital’, Bologna). We collected data from L1 CD patients who underwent MRE at diagnosis between January 2011 and December 2022, with a minimum follow‐up of 2 years. Univariate and multivariate Cox‐regression analyses were performed to investigate MRE predictors for the outcomes over time. Results Thirty‐four out of 383 (8.9%) CD paediatric patients met the inclusion criteria. Fifty per cent were male; median age at diagnosis was 14.1 years (interquartile range IQR 11.8–15.1 years). Ten patients (29.4%) underwent surgery, and 17/34 (50%) needed treatment escalation to anti‐TNF‐α during a median follow‐up of 4.5 years (Q1–Q3 2.4–6.6 years). Maximum bowel wall thickness (BWT) was the only MRE parameter independently associated with surgery (hazard ratio HR 1.54, 95% confidence interval CI 1.02–2.37, p = 0.04) and anti‐TNF‐α initiation (HR 1.56, 95% CI 1.1–2.22, p = 0.01) over time. BWT > 8 mm was the optimal cut‐off to identify patients who required surgery (sensitivity 78%, specificity 52%, area‐under‐the‐curve 0.73, 95% CI 0.54–0.92, p = 0.026). Conclusions BWT assessed at MRE performed at diagnosis was an independent predictor of surgery and treatment escalation over time in a paediatric cohort with L1 CD. BWT > 8 mm was the optimal cut‐off to identify patients at higher risk for surgery.
Pochesci et al. (2026) studied this question.