Evaluating inflammatory activity in Crohn’s disease by cross-sectional imaging techniques

Abstract The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.

Download Full-text

Performance of Capsule Endoscopy and Cross-Sectional Techniques in Detecting Small Bowel Lesions in Patients with Crohn’s Disease

Crohn's & Colitis 360 ◽

10.1093/crocol/otaa046 ◽

2020 ◽

Vol 2 (2) ◽

Author(s):

Carlo Calabrese ◽

Margherita Diegoli ◽

Nikolas Dussias ◽

Marco Salice ◽

Fernando Rizzello ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Capsule Endoscopy ◽

Imaging Techniques ◽

Cross Sectional ◽

Imaging Characteristics ◽

Cross Sectional Imaging ◽

Sectional Imaging

Abstract Background Crohn’s disease (CD) can be classified according to endoscopic and cross-sectional imaging characteristics. Information regarding disease extent and phenotype may be provided by advanced endoscopic and imaging techniques. In this study, we compare the ability of capsule endoscopy (CE) and cross-sectional imaging techniques (CST) (MRE/Computer Tomography Enteroscopy [CTE]) in detecting small bowel (SB) lesions. Methods We retrospectively analyzed 102 patients with a diagnosis of CD who underwent both CE and CST. Only patients with at least a 12-month follow-up after CE were included. Results Sensitivity and specificity for the detection of SB lesions were, respectively, 100% and 83.3% for CE, 55.1% and 80% for CTE, and 60% and 82.3% for MRE. CE detected proximal CD lesions in 73% of patients, whereas MRE and CTE detected proximal lesions in 41% and 16% of patients, respectively (P < 0.001). Positive findings on CE led to management changes in all patients, in a median follow-up period of 58.7 months. During the follow-up period, 26.5% of patients underwent surgery. Multivariate analysis revealed that moderate-to-severe disease at CE was independently correlated with surgery (P = 0.03). Conclusions CE has a superior sensitivity for detecting CD lesions in the proximal and medium SB compared with CST. In the terminal ileum, MRE and CTE displayed similar performance to CE.

Download Full-text

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.

Download Full-text

Differentiation of fibrotic and inflammatory component of Crohn’s disease-associated strictures

Intestinal Research ◽

10.5217/ir.2020.00015 ◽

2020 ◽

Vol 18 (2) ◽

pp. 144-150 ◽

Cited By ~ 2

Author(s):

Jordi Rimola ◽

Nunzia Capozzi

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Imaging Techniques ◽

Balloon Dilation ◽

Short Review ◽

Cross Sectional ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Inflammatory Component

Patients with Crohn’s disease (CD) commonly develop bowel strictures, which may contain various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment approach, fibrotic strictures would require endoscopic balloon dilation or surgery. Cross-sectional imaging surpasses endoscopy for characterization of stenotic segments and potentially may contribute to the optimal clinical management of these patients. This short review aims to discuss the potentialities and limitations of cross-sectional imaging techniques for assessing bowel fibrosis in patients with CD.

Download Full-text