Development and Validation of a Pediatric MRI-Based Perianal Crohn Disease (PEMPAC) Index-A Report from the ImageKids Study

Sapir Choshen, Dan Turner, Li Tal Pratt, Ronit Precel, Mary Louise Greer, Denise A. Castro, Amit Assa, Mariá I. Martínez-León, Izabela Herman-Sucharska, Eva Coppenrath, Osnat Konen, Jorge Davila, Elhamy Bekhit, Zehour Alsabban, Gili Focht, Matan Gavish, Anne Griffiths, Ruth Cytter-Kuint

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: As part of the prospective multicenter ImageKids study, we aimed to develop and validate the pediatric MRI-based perianal Crohn disease (PEMPAC) index. Methods: Children with Crohn disease with any clinical perianal findings underwent pelvic magnetic resonance imaging at 21 sites globally. The site radiologist and 2 central radiologists provided a radiologist global assessment (RGA) on a 100 mm visual analog scale and scored the items selected by a Delphi group of 35 international radiologists and a review of the literature. Two weighted multivariable statistical models were constructed against the RGA. Results: Eighty children underwent 95 pelvic magnetic resonance imaging scans; 64 were used for derivation and 31 for validation. The following items were included: Fistula number, location, length and T2 hyperintensity; abscesses; rectal wall involvement; and fistula branching. The last 2 items had negative beta scores and thus were excluded in a contending basic model. In the validation cohort, the full and the basic models had the same strong correlation with the RGA (r=0.75; P<0.01) and with the adult Van Assche index (VAI; r=0.93 and 0.92; P<0.001). The correlation of the VAI with the RGA was similar (r=0.77; P<0.01). The 2 models and the VAI had a similar ability to differentiate remission from active disease (area under the receiver operating characteristic curve, 0.91-0.94). The PEMPAC index had good responsiveness to change (area under the receiver operating characteristic curve, 0.89; 95% confidence interval, 0.69-1.00). Conclusions: Using a blended judgmental and mathematical approach, we developed and validated an index for quantifying the severity of perianal disease in children with CD. The adult VAI may also be used with confidence in children.

Original languageEnglish
Pages (from-to)700-709
Number of pages10
JournalInflammatory Bowel Diseases
Issue number5
StatePublished - 1 May 2022
Externally publishedYes


  • Crohn disease
  • abscess
  • fistula
  • inflammatory bowel disease
  • magnetic resonance imaging
  • pediatric
  • pediatrics
  • scoring

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy


Dive into the research topics of 'Development and Validation of a Pediatric MRI-Based Perianal Crohn Disease (PEMPAC) Index-A Report from the ImageKids Study'. Together they form a unique fingerprint.

Cite this