1
A
B
C
D
E
F
G
H
Jejunum | Segment
2
A
B
C
D
E
F
G
H
Ileum | Segment
3
Terminal Ileum
4
Right Colon
5
Transverse Colon
6
Descending Colon
7
Sigmoid
8
Rectum
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- PICMI
About
PICMI (Pediatric Inflammatory Crohn's Magnetic Resonance Enterography [MRE] Index)1
Aim: to standardize the scoring of transmural inflammation in children with Crohn’s disease across all segments of the intestine, without the need for contrast enemas or intravenous gadolinium.
Five items were identified during the development and validation of the PICMI: wall thickness, wall diffusion weighted imaging (DWI), ulcerations, mesenteric edema, and comb sign, all should be scored in all bowel segments. The weighted global PICMI correlated well with several contrasts of disease activity including for instance radiologist global assessment and endoscopic degree of inflammation. Interobserver and test-retest reliability were high, and at repeated visits, responsiveness was excellent. PICMI ≤10 defines transmural healing, while response is defined as a change of >20 points (area under the receiver operating characteristic curve 0.96 [95%CI 0.93-0.99]).
Calculator
1
Jejunum
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
B
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
C
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
D
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
E
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
F
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
G
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
1
Jejunum
Segment
H
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
B
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
C
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
D
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
E
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
F
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
G
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
2
Ileum
Segment
H
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
3
Terminal Ileum
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
4
Right Colon
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
5
Transverse Colon
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
6
Descending Colon
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
7
Sigmoid
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
8
Rectum
Segment
A
Wall thickness
Measure the thickest part within the segment. Round mm to the nearest whole number.
Ulceration
Mucosal indentation smaller than the full thickness of the bowel wall
Wall restricted diffusion
A subjective measure of hyperintensity on highest b value trace image compared to normal bowel
Mesenteric edema
T2 hyperintense signal of the mesentery adjacent to the same bowel loop assessed
Comb sign
Vascular engorgement related to the bowel loop assessed
Total Score:
User guide notees:
The total PICMI score is the sum of the segmental scores for each of the involved segments: jejunum, ileum, terminal ileum (10 cm from the ileo-cecal valve), right colon, transverse colon, descending colon, sigmoid, and rectum (the jejunum and ilium are divided into eight segments, one or more of which can be scored if involved).
Segmental PICMI (scored based on the worst part) = wall thickness (≥3mm) x 3 + ulceration (0/1) x 6 + wall restricted diffusion (0/1) x 9 + mesenteric edema (0/1) x 6 + comb sign (0/1) x 9
Small bowel scoring: If there is > 20 cm of affected bowel in the jejunum or ileum, each 20 cm length is scored as a separate segment. For example, 18 cm is one segment, 25 cm or 36cm are two segments, and 44 cm is three separate segments (20 + 20 + 4), each receiving its own segmental score as above.
Continuous disease versus skip lesions: If the distance between two segments of affected small bowel is ≤ 20 cm, the unaffected bowel is included in the length measurement and is considered part of continuous disease. If the unaffected bowel between two affected segments is >20 cm, the two affected segments are considered skip lesions, and scored separately as two different segments.
Cutoff values in the total PICMI score to determine severity of transmural inflammation:
≤10 Remission
11-55 Mild inflammation
56-120 Moderate inflammation
>120 Severe inflammation
A score change in the PICMI of >20 points define response (i.e. minimally important difference of the PICMI)
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