ACR Appropriateness Criteria® Crohn Disease

Kim, David H.; Chang, Kevin J.; Fowler, Kathryn J.; Cash, Brooks D.; García, Encarnación Martínez; Kambadakone, Avinash; Levy, Angela D.; Liu, Peter S.; Mace, Sharon E.; Marin, Daniele; Moreno, Courtney C.; Peterson, Christine; Pietryga, Jason A.; Solnes, Lilja B.; Weinstein, Stefanie; Carucci, Laura R.

doi:10.1016/j.jacr.2020.01.030

Cited by 19 publications

(14 citation statements)

References 119 publications

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“…Cross-sectional imaging methods are increasingly gaining ground, becoming essential in the diagnosis and follow-up of patients with Crohn's disease, although their utility is limited in the initial stages of the disease, when the lesions are still subtle and limited to the mucosa. Currently, CTE is the cross-sectional method of choice in the evaluation of such patients at most health care facilities and is the method recommended by the American College of Radiology in most clinical situations related to Crohn's disease (39) , although MRE has also shown very high accuracy. In addition, recent studies have demonstrated that MRE has become the reference standard in the assessment of the inflammatory activity of the disease, especially in perianal manifestations (40) .…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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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.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2020

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“…A total of 367 consecutive patients with CD with no history of bowel surgery and who had undergone MRE between July 2019 and February 2020 at Asan Medical Center, a tertiary referral center, were initially recruited. The indications for MRE in CD at our institution were consistent with those recommended [2,11] for the baseline or followup assessment for medical therapy. After reviewing the technical notes taken at the time of MRE examination, to avoid confounding effects on bowel distention, we excluded three patients who did not receive the complete oral fluid administration required for MRE, leaving a study cohort comprising 364 patients (269 male and 95 female; mean age ± standard deviation, 31.2 ± 9.4 years).…”

Section: Study Participantsmentioning

confidence: 69%

“…Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) are the primary imaging modalities used to evaluate patients with Crohn's disease (CD) [1][2][3]. Owing to the absence of radiation exposure, Flattening in the Anteroposterior Direction of the Terminal Ileum or Sigmoid Colon Lying Across the Psoas Muscle on Magnetic Resonance Enterography in Patients with Crohn's Disease MRE is particularly useful for patients with CD, who tend to be young and require lifelong repetitive examinations [4,5].…”

Section: Introductionmentioning

confidence: 99%

Flattening in the Anteroposterior Direction of the Terminal Ileum or Sigmoid Colon Lying Across the Psoas Muscle on Magnetic Resonance Enterography in Patients with Crohn's Disease

et al. 2021

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Objective: Flattening in the anteroposterior direction (AP flattening) of the terminal ileum (TI) or sigmoid colon (SC) lying across the psoas muscle, on magnetic resonance enterography (MRE), might mimic bowel inflammation in the coronal view. This study investigated the prevalence of AP flattening and the factors associated with its development. Materials and Methods: A total of 364 surgery-naïve patients with Crohn's disease (CD) who had undergone MRE were retrospectively reviewed. AP flattening was defined as a luminal collapse in the anteroposterior direction, with a bowel width in the axial plane < 1/4 of the normal diameter without reduction of bowel width in coronal images. The prevalence of AP flattening of the TI and SC on MRE in patients with bowel segments lying across the psoas muscle was determined. We further compared the rate of AP flattening between MRE and computed tomography enterography (CTE) in a subcohort of patients with prior CTE. The factors associated with AP flattening were analyzed using multivariable logistic regression in a subcohort of patients with endoscopic findings of TI. Results: Three hundred and twenty-two and 363 patients, respectively, had TI and SC lying across the psoas muscle. The prevalence of AP flattening on MRE was 7.5% (24/322) in TI and 5.2% (19/363) in SC. The prevalences were significantly higher on MRE than on CTE in both the TI (7.3% [12/164] vs. 0.6% [1/164]; p = 0.003) and SC (5.8% [11/190] vs. 1.6% [3/ 190]; p = 0.039). AP flattening of the TI was independently and strongly associated with the absence of CD inflammation on endoscopy, with an adjusted odds ratio of 0.066 (p = 0.003) for the presence versus the absence (reference) of inflammation. Conclusion: AP flattening of the TI or SC lying across the psoas muscle was uncommon and predominantly observed on MRE of the bowel without CD inflammation.

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“…It provides high resolution, multiplanar reformatted images [13][14][15]. CTE is the fastest and the most appropriate imaging modality for evaluating active inflammatory bowel disease and its complications [16]. The only disadvantage of this technique is the radiation exposure [17].…”

Section: Discussionmentioning

confidence: 99%

The efficacy of new oral contrast mixture for computed tomography enterography

2019

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Purpose: To show the reliabilities of the new mixture (composed of water, methylcellulose, lactulose, locust bean gum, and sorbitol) and to compare the luminal distension and radiological confidence scores of this solution with water-lactulose mixture. Material and methods: Computed tomography enterography (CTE) images in a three-year period were included randomly in our institutional review board-approved and retrospective study. Ninety-one patients drank a lactulose and water mixture (Group 1), and 54 patients drank the new mixture (Group 2). Patients who drank the oral contrast agent were taken to a 64-detector row multiple detector computed tomography machine. Coronal and sagittal reformatted images were also formed. The gastrointestinal tract was divided into 11 segments for scoring. Each segment was graded for distensional and radiological confidence. CTE images were evaluated by two radiologists. Results: Inter-and intra-reader reliabilities were good or excellent for all gastrointestinal segments in both groups (p < 0.001). The best κ values were obtained in sigmoid colon assessments. Lower agreement values were detected in duodenum and jejunum scores. The new mixture group (Group 2) showed better results than Group 1 for ileum and colonic segments according to distension and confidence scorings. Conclusions: Inter-and intra-reader reliabilities of the new mixture were good or excellent for CTE. The new mixture seems to be more efficient and reliable for ileum and colon. The new mixture can increase bowel distention, radiological confidence, and quality in CTE evaluations.

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ACR Appropriateness Criteria® Crohn Disease

Cited by 19 publications

References 119 publications

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

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

Flattening in the Anteroposterior Direction of the Terminal Ileum or Sigmoid Colon Lying Across the Psoas Muscle on Magnetic Resonance Enterography in Patients with Crohn's Disease

The efficacy of new oral contrast mixture for computed tomography enterography

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