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

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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Su1900 - Automated Image Analysis of CT Enterography Studies Predicts Future Surgery Similar to Experienced Radiologist Assessment in small Bowel Crohn's Disease

Gastroenterology ◽

10.1016/s0016-5085(18)32246-7 ◽

2018 ◽

Vol 154 (6) ◽

pp. S-625-S-626

Author(s):

Ryan W. Stidham ◽

Binu Enchakalody ◽

Akbar K. Waljee ◽

Peter D. Higgins ◽

Stewart Wang ◽

...

Keyword(s):

Image Analysis ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Automated Image Analysis ◽

Ct Enterography ◽

Experienced Radiologist

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Capsule Endoscopy in the Evaluation of Obscure GI Bleeding, Crohn's Disease and Other Small Bowel Pathology: Diagnostic Yield, and Comparison with Endoscopic & CT-Radiographic Studies in a Tertiary Care Referral Center

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2006.03.362 ◽

2006 ◽

Vol 63 (5) ◽

pp. AB171 ◽

Cited By ~ 1

Author(s):

Parul Dureja ◽

Robert R. Agarwal ◽

Adnan Said ◽

Sigurdur Einarsson ◽

Patrick Pfau ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Diagnostic Yield ◽

Tertiary Care ◽

Gi Bleeding ◽

Referral Center

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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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Small-Bowel Capsule Endoscopy in Patients with Suspected Crohn's Disease—Diagnostic Value and Complications

Diagnostic and Therapeutic Endoscopy ◽

10.1155/2010/101284 ◽

2010 ◽

Vol 2010 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Pedro Figueiredo ◽

Nuno Almeida ◽

Sandra Lopes ◽

Gabriela Duque ◽

Paulo Freire ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Inflammatory Markers ◽

Diagnostic Yield ◽

Villous Atrophy ◽

Tertiary Care ◽

Endoscopic Findings ◽

Capsule Retention

Background. The aim of this work was to assess the value of capsule enteroscopy in the diagnosis of patients with suspected Crohn's Disease (CD). Methods. This was a retrospective study in a single tertiary care centre involving patients undergoing capsule enteroscopy for suspected CD. Patients taking nonsteroidal anti inflammatory drugs during the thirty preceding days or with a follow-up period of less than six months were excluded. Results. Seventy eight patients were included. The endoscopic findings included mucosal breaks in 50%, ulcerated stenosis in 5%, and villous atrophy in 4%. The diagnosis of CD was established in 31 patients. The sensitivity, specificity, positive and negative predictive value of the endoscopic findings were 93%, 80%, 77%, and 94%, respectively. Capsule retention occurred in four patients (5%). The presence of ulcerated stenosis was significantly more frequent in patients with positive inflammatory markers. The diagnostic yield of capsule enteroscopy in patients with negative ileoscopy was 56%, with a diagnostic acuity of 93%. Conclusions. Small bowel capsule endoscopy is a safe and valid technique for assessing patients with suspected CD. Capsule retention is more frequent in patients with positive inflammatory markers. Patients with negative ileoscopy and suspected CD should be submitted to capsule enteroscopy.

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Clinical utility of small bowel ultrasound assessment of Crohn’s disease in adults: a systematic scoping review

Frontline Gastroenterology ◽

10.1136/flgastro-2021-101897 ◽

2021 ◽

pp. flgastro-2021-101897

Author(s):

Shellie Jean Radford ◽

Chris Clarke ◽

Bethany Shinkins ◽

Paul Leighton ◽

Stuart Taylor ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Clinical Decision Making ◽

Imaging Modality ◽

Point Of Care ◽

Clinical Decision ◽

Search Terms ◽

The Uk ◽

Bowel Ultrasound

BackgroundUltrasound (US) is an alternative to magnetic resonance enterography, and has the potential to significantly reduce waiting times, expedite clinical decision-making and improve patient experience. Point of care US is an advantage of the US imaging modality, where same day scanning, interpretation and treatment decisions can be made.AimTo systematically scope the literature on point of care US use in small bowel Crohn’s disease, generating a comprehensive list of factors relating to the current understanding of clinical utility of this imaging modality.MethodsSearches included MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, clinicaltrial.gov,‘TRIP’ and Epistemonikos. Reference lists of included studies were hand searched. Search terms were searched for as both keywords and subject headings (MeSH) as appropriate. Searches were performed with the ‘suggested search terms’ and ‘explode’ selection, and restricted to ‘human’, ‘adult’ and ‘English language’ publications. No date limits were applied to be as inclusive as possible. Two investigators conducted abstract and full-text review. No formal quality appraisal process was undertaken; however, quality of sources was considered when reporting findings. A narrative synthesis was conducted.ResultsThe review included 42 sources from the UK, Europe, Japan, Canada and the USA. Small bowel ultrasound (SBUS) has been shown to be as accurate in detecting the presence of small bowel Crohn’s disease, is quicker, safer and more acceptable to patients, compared with magnetic resonance enterography. SBUS is used widely in central Europe and Canada but has not been embraced in the UK. Further research considering economic evaluation, clinical decision-making and exploration of perceived barriers to future implementation of SBUSs is required.

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