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PEMPAC

Pediatric magnetic resonance imaging [MRI]-based perianal Crohn's disease index
  • PEMPAC
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PEMPAC (Pediatric magnetic resonance imaging [MRI]-based perianal Crohn's disease) index 1

Aim: to score the degree of perianal disease in children with Crohn’s disease using pelvic MRI. 

The PEMPAC index includes the number of fistulas, their location, and length, and T2 hyperintensity, as well as the presence of abscesses. The index differentiated perianal remission from active disease, with an area under the receiver operating characteristic curve (AUC) of 0.91(95%CI 0.86-0.97) to 0.94 (95%CI 0.89-0.98). Good responsiveness to change was seen for the PEMPAC index with an AUC of 0.89 (95%CI 0.69-1.00).

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Maximal hyperintensity on T2-weighted imaging
Total length of fistulas
Number of fistulas
Collections (>3mm)
Location
Total Score:
Remission
Mild disease
Moderate disease
Severe disease

Cutoff values of PEMPAC to determine severity of perianal disease: 

PEMPAC < 10 (remission)
PEMPAC 10-15 (mild disease)
PEMPAC 16-29 (moderate disease)
PEMPAC ≥ 30 (severe disease). 

A change of at least 4 points denotes response. In patients with more than one fistula, the location should be scored according to the highest scoring fistula.