Diagnostic role of computed tomography enterography (CTE) in assessment of intra-mural and extra-intestinal CT findings in active Crohn’s disease (CD)

Abstract Background Crohn’s disease (CD) is a ruinous bowel disease, which, if left uncured, leads to penetrating bowel complications. Computed tomography enterography (CTE) is nowadays accepted as a principal modality for the assessment of small bowel diseases. The aim of this study is to assess the role of CT enterography in the identification of intramural as well as extra-intestinal CT changes yielding more thorough data about the level and severity of the disease process thus planning appropriate treatment strategy. Results From March 2017 to January 2019, 50 patients in Cairo, Egypt, who had clinical manifestations of inflammatory bowel disease, were evaluated by MDCTE. CT image analysis was processed, including anatomical localization of bowel segments affection, assessment of mucosal thickening and hyper-enhancement, and extra-enteric affection. Diagnosis of Crohn’s disease (CD) was confirmed by endoscopy and histopathology; mucosal thickening was seen in 42 patients (84%), mucosal hyper-enhancement was seen in 44 patients (88%) while engorgement of vasa recta (comb’s sign) was seen in 38 patients (76%). Conclusion Although ileocolonoscopy is a proven sensitive method to detect mucosal injury and diagnose disease activity, it is limited by its maximal extent and inability to detect transmural complications as well as limited ability to assess deep bowel wall involvement. CT enterography (CTE) is a valuable technique in diagnostic evaluation of intramural and extra-intestinal involvement in Crohn’s disease (CD) during disease activity.

Download Full-text

S1221 Computed Tomography Enterography and Small Bowel Ultrasound in Assessing Ileal Crohn's Disease Activity

Gastroenterology ◽

10.1016/s0016-5085(08)60943-9 ◽

2008 ◽

Vol 134 (4) ◽

pp. A-204

Author(s):

Alessandra Losco ◽

Chiara Trattenero ◽

Mirella Fraquelli ◽

Laura Virginia Forzenigo ◽

Sara Massironi ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Disease Activity ◽

Computed Tomography Enterography ◽

Crohn’S Disease Activity ◽

Bowel Ultrasound

Download Full-text

Monitoring Crohn’s disease activity: endoscopy, fecal markers and computed tomography enterography

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284818769075 ◽

2018 ◽

Vol 11 ◽

pp. 175628481876907 ◽

Cited By ~ 5

Author(s):

Susana Lopes ◽

Patrícia Andrade ◽

Joana Afonso ◽

Rui Cunha ◽

Eduardo Rodrigues-Pinto ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Rank Correlation ◽

Response To Therapy ◽

Newly Diagnosed ◽

Mesenteric Fat ◽

Computed Tomography Enterography

Background: The treatment goal of Crohn’s disease (CD) has moved towards achieving mucosal healing, resolution of transmural inflammation, and normalization of biomarkers. The purpose of this study was to evaluate how well computed tomography enterography (CTE) and fecal calprotectin (FC) correlated with endoscopic activity in newly diagnosed patients with CD and after 1 year of therapy. Methods: Consecutive patients with newly diagnosed CD were evaluated by endoscopy, CTE, and FC at diagnosis and 12 months after beginning immunosuppression. Endoscopic severity was assessed using the Simplified Endoscopic Score for Crohn’s Disease (SES-CD). Biomarkers, clinical indexes, and FC were recorded on the day of ileocolonoscopy at diagnosis and 1 year after diagnosis. We adapted a CTE score for disease activity based on radiological signs of inflammation (i.e. mural thickness, mural hyperenhancement, mesenteric fat proliferation, mesenteric fat densification, comb sign, presence of strictures, fistulas, abscesses, ascites, and lymphadenopathy). Correlations between endoscopy, CTE, and FC were assessed using Spearman’s rank correlation. Results: A total of 29 patients (48% women; median age 30 (24.5–35.5) years) were included in this prospective cohort. CTE findings significantly correlated with endoscopic findings. Endoscopic remission (ER) at 1-year follow up significantly correlated with improvement in mural hyperenhancement ( p = 0.004), mesenteric fat densification ( p = 0.001), comb sign ( p = 0.004), and strictures ( p = 0.008) in CTE. None of the CTE findings improved in patients without ER. FC correlated with SES-CD ( rs = 0.696, p < 0.001) and with CTE features of inflammation ( rs = 0.596, p < 0.001). A cut-off of 100 µg/g predicted ER with 92% sensitivity, 65% specificity, and 83% accuracy (area under curve 0.878, p < 0.001). Conclusions: CTE findings and FC levels correlated with endoscopic activity in CD both at diagnosis and at 1-year follow up. These two noninvasive markers of disease activity may be used as an alternative to endoscopy to monitor disease response to therapy.

Download Full-text

Quantitative measurement and visual assessment of ileal Crohn's disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein

Gut ◽

10.1136/gut.2005.084301 ◽

2006 ◽

Vol 55 (11) ◽

pp. 1561-1567 ◽

Cited By ~ 164

Author(s):

J F Colombel ◽

C A Solem ◽

W J Sandborn ◽

F Booya ◽

E V Loftus ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Quantitative Measurement ◽

Visual Assessment ◽

C Reactive Protein ◽

Reactive Protein ◽

Computed Tomography Enterography ◽

Crohn’S Disease Activity

Download Full-text

Intestinal Ultrasound in Inflammatory Bowel Disease: A Valuable and Increasingly Important Tool

GE Portuguese Journal of Gastroenterology ◽

10.1159/000520212 ◽

2021 ◽

pp. 1-17

Author(s):

Catarina Frias-Gomes ◽

Joana Torres ◽

Carolina Palmela

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Bowel Disease ◽

Response To Therapy ◽

Inflammatory Bowel

Background: Intestinal ultrasound is emerging as a non-invasive tool for monitoring disease activity in inflammatory bowel disease patients due to its low cost, excellent safety profile, and availability. Herein, we comprehensively review the role of intestinal ultrasound in the management of these patients. Summary: Intestinal ultrasound has a good accuracy in the diagnosis of Crohn’s disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses. Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn’s disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery. Similarly to Crohn’s disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy. Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis. Key Messages: Intestinal ultrasound is a valuable tool to assess disease activity and complications, and to monitor response to therapy. Even though longer prospective data are warranted, intestinal ultrasound may lead to a change in the paradigm of inflammatory bowel disease management as it can be used in a point-of-care setting, enabling earlier intervention if needed.

Download Full-text

PA.158 ASSESSMENT OF CROHN'S DISEASE ACTIVITY BY COMPUTED TOMOGRAPHY ENTEROGRAPHY IN PATIENTS WITH AND WITHOUT STENOSIS: A CORRELATION WITH BIOCHEMICAL INDEXES OF ACTIVITY

Digestive and Liver Disease ◽

10.1016/s1590-8658(08)60353-9 ◽

2008 ◽

Vol 40 ◽

pp. S133

Author(s):

G. Maconi ◽

E. Radice ◽

A. Cassinotti ◽

M. Bosani ◽

G. Bianchi Porro

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Computed Tomography Enterography ◽

Crohn’S Disease Activity

Download Full-text

Computed tomography enterography in assessment of Crohn’s disease activity

Alexandria Journal of Medicine ◽

10.1016/j.ajme.2014.04.003 ◽

2015 ◽

Vol 51 (2) ◽

pp. 105-110

Author(s):

Enas Abdel Ghany Ibrahim ◽

Leila Rawash El-Dieb ◽

Nivine Chalabi ◽

Noha Mohamed Osman

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Disease Activity ◽

Computed Tomography Enterography ◽

Crohn’S Disease Activity

Download Full-text

Using computed tomography enterography to evaluate patients with Crohn's disease: what impact does examiner experience have on the reproducibility of the method?

Radiologia Brasileira ◽

10.1590/0100-3984.2015.0131 ◽

2017 ◽

Vol 50 (1) ◽

pp. 13-18 ◽

Cited By ~ 3

Author(s):

Stênio Burlin ◽

Larissa Rossini Favaro ◽

Elisa Almeida Sathler Bretas ◽

Lincoln Seiji Taniguchi ◽

Ana Paula Loch ◽

...

Keyword(s):

Computed Tomography ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Interobserver Agreement ◽

Ct Enterography ◽

Cross Sectional ◽

Kappa Test ◽

Computed Tomography Enterography ◽

The Impact

Abstract Objective: To assess the impact that examiner experience has on the reproducibility and accuracy of computed tomography (CT) enterography in the detection of radiological signs in patients with Crohn's disease. Materials and Methods: This was a retrospective, cross-sectional observational study involving the analysis of CT enterography scans of 20 patients with Crohn's disease. The exams were analyzed independently by two radiologists in their last year of residence (duo I) and by two abdominal imaging specialists (duo II). The interobserver agreement of each pair of examiners in identifying the main radiological signs was calculated with the kappa test. The accuracy of the examiners with less experience was quantified by using the consensus among three experienced examiners as a reference. Results: Duo I and duo II obtained a similar interobserver agreement, with a moderate to good correlation, for mural hyperenhancement, parietal thickening, mural stratification, fat densification, and comb sign (kappa: 0.45-0.64). The less experienced examiners showed an accuracy > 80% for all signs, except for lymph nodes and fistula, for which it ranged from 60% to 75%. Conclusion: Less experienced examiners have a tendency to present a level of interobserver agreement similar to that of experienced examiners in evaluating Crohn's disease through CT enterography, as well as showing satisfactory accuracy in identifying most radiological signs of the disease.

Download Full-text