Comparison of diagnostic performance between 1 millisievert CT enterography and half-standard dose CT enterography for evaluating active inflammation in patients with Crohn’s disease

Patients with Crohn’s disease (CD) have higher risk for osteoporosis following decreased level of osteocalcin. We hypothesize that active inflammation following Mycobacterium avium subsp. paratuberculosis (MAP) infection results in elevation of undercarboxylated osteocalcin (ucOC) and downregulation of active osteocalcin in CD patients and cow-disease model (Johne’s disease). In this study, we measured ucOC, active osteocalcin, and calcium levels in sera from 42 cattle (21 infected with MAP and 21 healthy cattle), 18 CD patients, and 20 controls. The level of ucOC in MAP+ bovine samples was higher than that in MAP− controls (318 ± 57.2 nmol/mL vs. 289 ± 95.8 nmol/mL, P > 0.05). Consequently, mean calcium level in bovine MAP+ was significantly higher than that in bovine-MAP− samples (9.98 ± 0.998 mg/dL vs. 7.65 ± 2.12 mg/dL, P < 0.05). Also, the level of ucOC was higher in CD-MAP+ than in CD-MAP− (561 ± 23.7 nmol/mL vs. 285 ± 19.6 nmol/mL, P < 0.05). Interestingly, the mean osteocalcin level in MAP+ bovine was lower than that in MAP− bovine (797 ± 162 pg/mL vs. 1190 ± 43 pg/mL) and it was lower in CD-MAP+ than in CD-MAP− infection (1.89 ± 0.184 ng/mL vs. 2.19 ± 0.763 ng/mL) (P < 0.05). The correlation between MAP infection and elevation of sera ucOC, reduction of active osteocalcin and increased calcium supports MAP infection role in CD and complications with osteoporosis.

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Computed tomography and magnetic resonance imaging in the diagnosis of the small and large intestine strictures in Crohn’s disease. Radiological semiotics and assessment of the inflammation activity

Almanac of Clinical Medicine ◽

10.18786/2072-0505-2018-46-7-725-733 ◽

2018 ◽

Vol 46 (7) ◽

pp. 725-733

Author(s):

S. E. Dubrova ◽

G. A. Stashuk ◽

N. V. Nikitina ◽

Yu. K. Bogomazov

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Chronic Inflammation ◽

Intestinal Wall ◽

Arterial Phase ◽

Resonance Imaging ◽

Active Inflammation ◽

Delayed Phase ◽

Small And Large Intestine

Rationale: Crohn's disease is characterized by continuous severe course, and in a half of the patients is associated with formation of strictures that are difcult to treat and signifcantly decrease quality of life. Difculties during the diﬀerentiation between inﬂammation-related and fbrostenotic strictures and divergent approaches to their treatment in patients with Crohn's disease indicate the need in precise diagnostics and systematization of the radiological semiotics of strictures.Aim: To propose radiological semiotics of the small and large intestine strictures based on the results of multiaxial computed tomography (MACT) and magnetic resonance imaging (MRI).Materials and methods: MACT and MRI visualization was performed in 40 patients with a stenotic type of Crohn's disease.Results: The radiological signs of the strictures were classifed into two main groups: intestinal and extra-intestinal. They were systematized according to nine criteria, such as character of formation, etiology, number, inﬂammation grade, extension, shape, and location, presence of ileus and presence of other complications. The inﬂammation activity in the intestinal wall was evaluated during the postcontrast assessment: active inﬂammation in the arterial phase (at 25 seconds after administration of the contrast agent), chronic inﬂammation in the delayed phase (at 10 minutes). The MRI results were cross-checked with those of MACT. At the precontrast stage, MRI was more informative as per the width of the intestinal lumen, whereas MACT was preferential in the diagnosis of fat infltration of the intestinal wall. Post-contrast MACT and MRI were diagnostically equivalent. The most indicative for active inﬂammation were diﬀuse weighed MRI images, arterial phase MACT and MRI, whereas chronic inﬂammation and wall fbrosis were better diagnosed at the delayed phase (at 10 minutes) of MACT and MRI. Both methods (MACT and MRI) could not diﬀerentiate between the submucous and muscular layers of the intestinal wall. Mixed type of inﬂammation was seen in the walls of intestinal strictures: chronic inﬂammation dominated in the intermediate, most extensive part of a stricture and remained stable during the dynamic follow-up, whereas active inﬂammation was found in the marginal parts of the strictures, which were most susceptible to changes during the follow-up.Conclusion: Based on a set of certain signs obtained by radiological visualization, we propose a registry for stricture assessment based on evaluation of the inﬂammation activity.

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Assessing Small Bowel Stricturing and Morphology in Crohn’s Disease Using Semi-automated Image Analysis

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz196 ◽

2019 ◽

Vol 26 (5) ◽

pp. 734-742 ◽

Cited By ~ 3

Author(s):

Ryan W Stidham ◽

Binu Enchakalody ◽

Akbar K Waljee ◽

Peter D R Higgins ◽

Stewart C Wang ◽

...

Keyword(s):

Image Analysis ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Structural Damage ◽

Clinical Decision Making ◽

Tertiary Care ◽

Automated Image Analysis ◽

Image Analysis System ◽

Ct Enterography

Abstract Background Evaluating structural damage using imaging is essential for the evaluation of small intestinal Crohn’s disease (CD), but it is limited by potential interobserver variation. We compared the agreement of enterography-based bowel damage measurements collected by experienced radiologists and a semi-automated image analysis system. Methods Patients with small bowel CD undergoing a CT-enterography (CTE) between 2011 and 2017 in a tertiary care setting were retrospectively reviewed. CT-enterography studies were reviewed by 2 experienced radiologists and separately underwent automated computer image analysis using bowel measurement software. Measurements included maximum bowel wall thickness (BWT-max), maximum bowel dilation (DIL-max), minimum lumen diameter (LUM-min), and the presence of a stricture. Measurement correlation coefficients and paired t tests were used to compare individual operator measurements. Multivariate regression was used to model identification of strictures using semi-automated measures. Results In 138 studies, the correlation between radiologists and semi-automated measures were similar for BWT-max (r = 0.724, 0.702), DIL-max (r = 0.812, 0.748), and LUM-min (r = 0.428, 0.381), respectively. Mean absolute measurement difference between semi-automated and radiologist measures were no different from the mean difference between paired radiologists for BWT-max (1.26 mm vs 1.12 mm, P = 0.857), DIL-max (2.78 mm vs 2.67 mm, P = 0.557), and LUM-min (0.54 mm vs 0.41 mm, P = 0.596). Finally, models of radiologist-defined intestinal strictures using automatically acquired measurements had an accuracy of 87.6%. Conclusion Structural bowel damage measurements collected by semi-automated approaches are comparable to those of experienced radiologists. Radiomic measures of CD will become an important new data source powering clinical decision-making, patient-phenotyping, and assisting radiologists in reporting objective measures of disease status.

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Ileal Crohn's disease activity predicted by ruler: CT enterography histopathology correlation

The Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1016/j.ejrnm.2017.01.001 ◽

2017 ◽

Vol 48 (1) ◽

pp. 7-13

Author(s):

Tamer W. Kassem

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Ct Enterography ◽

Crohn’S Disease Activity

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Low-Dose CT Examinations in Crohn's Disease: Impact on Image Quality, Diagnostic Performance, and Radiation Dose

American Journal of Roentgenology ◽

10.2214/ajr.09.3420 ◽

2010 ◽

Vol 195 (1) ◽

pp. 78-88 ◽

Cited By ~ 68

Author(s):

Avinash R. Kambadakone ◽

Priyanka Prakash ◽

Peter F. Hahn ◽

Dushyant V. Sahani

Keyword(s):

Crohn’S Disease ◽

Image Quality ◽

Crohn's Disease ◽

Radiation Dose ◽

Diagnostic Performance ◽

Low Dose ◽

Low Dose Ct ◽

Disease Impact

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Low Sensitivities of MR- and CT-Enterography for Detection of Small Bowel Stenosis in Patients With Known Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(11)63155-7 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-759-S-760 ◽

Cited By ~ 1

Author(s):

Michael D. Jensen ◽

Jens Kjeldsen ◽

Søren R. Rafaelsen ◽

Torben Nathan

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Ct Enterography

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Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn’s Disease

Digestive Diseases ◽

10.1159/000487589 ◽

2018 ◽

Vol 36 (3) ◽

pp. 184-193 ◽

Cited By ~ 5

Author(s):

Lucrezia Laterza ◽

Anna Chiara Piscaglia ◽

Laura Maria Minordi ◽

Iolanda Scoleri ◽

Luigi Larosa ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Mucosal Healing ◽

Hospitalization Rate ◽

Clinical Activity ◽

Ct Enterography ◽

Complementary Information ◽

Endoscopic Remission ◽

Rutgeerts Score

Aim: To evaluate if a single and/or combined (clinical, endoscopic and radiological) assessment could predict clinical outcomes in Crohn’s disease (CD). Methods: We prospectively evaluated 57 CD cases who underwent both a colonoscopy and a CT-enterography (CTE). Harvey-Bradshaw Index (HBi), SES-CD (and/or Rutgeerts score) and the radiological disease activity were defined to stratify patients according to clinical, endoscopic and radiological disease activity respectively. Hospitalizations, surgery, therapeutic changes and deaths were evaluated up to 36 months (time 1) for 53 patients. Results: CTE and endoscopy agreed in stratifying disease activity in 47% of cases (k = –0.05; p = 0.694), CTE and HBi in 35% (k = 0.09; p = 0.08), endoscopy and HBi in 39% (k = 0.13; p = 0.03). Taken together, CTE, endoscopy and HBi agreed only in 18% of cases (k = 0.01; p = 0.41). Among the 11 cases with mucosal healing, only 3 (27%) showed transmural healing. Patients with endoscopic activity needed significantly more changes of therapy compared to patients with endoscopic remission (p = 0.02). Patients with higher transmural or clinical activity at baseline required significantly more hospitalizations (p < 0.01). Hospitalization rate decreases with an increase in the number of parameters indicating remissions at baseline (p = 0.04). Conclusions: Clinical, endoscopic and radiological assessments offer complementary information and could predict different mid-term outcomes in CD.

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