P111 Cross-sectional imaging is highly sensitive in detecting endoscopic post-operative recurrence in Crohn’s disease patients

Abstract Background Postoperative Crohn’s disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging in post-operative CD surveillance is less clear. We aimed to evaluate radiographic characteristics, endoscopic concordance, and the predictive ability of imaging for postoperative recurrence (POR). Methods Multi-institution retrospective cohort study of adult CD patients who underwent ileocolonic resection (ICR) between 2009–2020. Patients with a CT or MR enterography within 90 days of a postoperative surveillance colonoscopy were included. Imaging studies were interpreted by blinded expert CD radiologists. Endoscopic activity was assessed by Rutgeerts’ scoring (POR ≥ i2b). Patients were categorized by presence of endoscopic POR (E+ or E-) or radiographic disease activity (R+ or R-) and grouped by endoscopic and radiographic concordance. Results 201 CD patients (57.7% female, mean age 31 years, 81.2% stricturing CD, 17.9% >1 prior ICR, 22.5%) with paired colonoscopy and imaging were included. Median time from ICR to paired endoscopy was 23.2 months. Imaging was highly sensitive for detecting POR (84.2%), but poorly specific (32.8%). The plurality (41.8%, N=84) were discordant E-/R+, 32.8% concordant positive (E+/R+), 20.4% concordant negative (E-/R-), and 5% discordant E+/R-. In patients with endoscopic POR, imaging detected intestinal wall thickening (86.8%; p=0.004) and hyper-enhancement (84.2%; p=0.003) at higher rates and corresponded with endoscopic severity (Figure 1). Multiple correspondence analysis showed association between severe endoscopic (i3/i4) disease and advanced radiographic disease. The majority (58.3 %) of E+/R- patients (N=12) had a Rutgeerts’ score of i2b. Majority of E-/R+ (N=84) had minimal/mild radiographic disease (81%). Differences in characteristics between the E-/R+ and E+/R+ was most pronounced in length of disease >10 cm (26.1%, 45.3%). Subsequent colonoscopies were performed in 74 E-/R+ (i0=28, i1=12, i2a=34) and 35 E-/R- (i0=20, i1=9, i2a=6) patients with 18 E-/R+ (24.3%; i0=8, i1=3, i2a=7) and 4 E-/R- (11.4%; i0=1, i1=2, i2a=1) patients developing POR (p=0.09). However, survival analysis between E-/R+ and E-/R- showed no difference to time to subsequent POR (p=0.24) (Figure 2). Imaging features at time of paired negative endoscopy did not predict subsequent endoscopic POR. Conclusion Cross-sectional imaging is highly sensitive to detect endoscopic POR; advanced radiographic disease correlates with increased endoscopic severity. Patients with no endoscopic recurrence in the presence of radiographic activity may require increased surveillance, though larger study cohorts are needed. Imaging compliments, but should not supplant, endoscopic POR surveillance paradigms.

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Luminal narrowing alone allows an accurate diagnosis of Crohn’s disease small bowel strictures at cross-sectional imaging

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa256 ◽

2020 ◽

Author(s):

Daniel Stocker ◽

Michael J King ◽

Maria El Homsi ◽

Guillermo Carbonell ◽

Octavia Bane ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Diagnostic Performance ◽

Mr Enterography ◽

Cross Sectional ◽

Luminal Narrowing ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Sensitivity Specificity

Abstract Background and Aims Current consensus recommendations define small bowel strictures (SBS) in Crohn’s disease (CD) on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to 1) evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and 2) compare the diagnostic performance of CT and MR enterography (MRE) for SBS diagnosis. Methods One hundred and eleven CD patients (81 with pathologically confirmed SBS, 30 controls) who underwent CT and/or MRE were assessed. Two radiologists (R1, R2) blinded to pathology findings independently assessed the presence of luminal narrowing and upstream SB dilation. Statistical analysis was performed for a) luminal narrowing with or without SB upstream dilation (“possible SBS”), b) luminal narrowing with upstream SB dilation ≥3cm (“definite SBS”). Results Sensitivity for detecting SBS was significantly higher using “possible SBS” (R1, 82.1%; R2, 77.9%) compared to “definite SBS” (R1, 62.1%; R2, 65.3%; p<0.0001) with equivalent specificity (R1, 96.7%; R2, 93.3%; p>0.9). Using criterion “possible SBS”, sensitivity/specificity were equivalent between CT (R1, 87.3%/93.3%; R2, 83.6%/86.7%) and MRE (R1, 75.0%/100%; R2: 70.0%/100%). Using criterion “definite SBS”, CT showed significantly higher sensitivity (78.2%) compared to MRE (40.0%) for R1 but not R2 with similar specificities (CT, 86.7%-93.3%; MRE, 100%). Conclusion SBS can be diagnosed using luminal narrowing alone without the need for upstream dilation. CT and MRE show similar diagnostic performance for SBS diagnosis using luminal narrowing with or without upstream dilation.

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P264. Meta-analytic Bayesian model for differentiating intestinal tuberculosis from Crohn’s disease utilising clinical, endoscopic, and cross-sectional imaging findings, and the interferon-gamma releasing assay

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjw019.383 ◽

2016 ◽

Vol 10 (suppl 1) ◽

pp. S225-S226

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Interferon Gamma ◽

Bayesian Model ◽

Intestinal Tuberculosis ◽

Imaging Findings ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Role of endoscopy, cross-sectional imaging and biomarkers in Crohn's disease monitoring

Gut ◽

10.1136/gutjnl-2012-303957 ◽

2013 ◽

Vol 62 (12) ◽

pp. 1806-1816 ◽

Cited By ~ 67

Author(s):

Jose-Manuel Benitez ◽

Marie-Alice Meuwis ◽

Catherine Reenaers ◽

Catherine Van Kemseke ◽

Paul Meunier ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Monitoring ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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The Clinical Impact of Cross-Sectional Imaging on Crohn’s Disease Management

Cross-Sectional Imaging in Crohn’s Disease ◽

10.1007/978-3-319-96586-4_1 ◽

2019 ◽

pp. 1-9

Author(s):

Ellen M. Zimmermann

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Management ◽

Clinical Impact ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Cross-Sectional Imaging in Crohn’s Disease

10.1007/978-3-319-96586-4 ◽

2019 ◽

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging

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Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review

Gut ◽

10.1136/gutjnl-2018-318081 ◽

2019 ◽

Vol 68 (6) ◽

pp. 1115-1126 ◽

Cited By ~ 43

Author(s):

Dominik Bettenworth ◽

Arne Bokemeyer ◽

Mark Baker ◽

Ren Mao ◽

Claire E Parker ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Sampling Error ◽

Imaging Techniques ◽

Balloon Dilation ◽

Cross Sectional ◽

Heterogeneous Distribution ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Main Components

Patients with Crohn’s disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.

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