Active Crohn Disease: CT Findings and Interobserver Agreement for Enteric Phase CT Enterography

Booya, Fargol; Fletcher, Joel G.; Huprich, James E.; Barlow, John M.; Johnson, C. Daniel; Fidler, Jeff L.; Solem, Craig A.; Sandborn, William J.; Loftus, Edward V.; Harmsen, William S.

doi:10.1148/radiol.2413051444

Cited by 178 publications

(122 citation statements)

References 26 publications

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“…The CTE finding of either enteric signs such as mural stratification and hyperenhancement or perienteric signs like mesenteric hypertrophy or engorged vasa recta, the socalled ''comb sign'', has been found to correlate either with endoscopic or histological inflammation or with acutephase proteins, with sometimes discrepant results [6,7,[10][11][12]. The importance of recognising the different patterns of disease, especially early in the disease course, may help in tailoring specific therapies, predicting future complications, and possibly offering better timing of surgical interventions [13].…”

Section: Introductionmentioning

confidence: 99%

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Cappello

Tudisca

et al. 2014

Radiol med

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Purpose Few studies have correlated computed tomography enterography (CTE) findings with Crohn's disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. Materials and methods The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn's Disease Activity Index (CDAI) and some biochemical markers (Creactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. Results CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). Conclusion The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.

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Section: Introductionmentioning

confidence: 99%

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Cappello

Tudisca

et al. 2014

Radiol med

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“…The most commonly used imaging features are well established in the literature for both CT scan [1][2][3][4] and MRI [5][6][7][8][9][10][11][12][13][14][15]. These include bowel wall thickening, bowel wall edema, perienteric edema and fluid, and mucosal, transmural, and possibly serosal hyperenhancement after intravenous contrast or gadolinium administration.…”

Section: Introductionmentioning

confidence: 99%

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

et al. 2014

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Purpose: The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. Materials and methods: 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. Results: For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. Conclusion: Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.Key words: MR enterography-Small bowelPeristalsis-Motility-Cine MRI-Crohn's disease Erratum to: Abdom Imaging DOI 10.1007/s00261-014-0258-yThe original publication did not include the images pertaining to the supplementary video files. This has been corrected in this article.Using MR enterography (MRE) to diagnose inflamed small bowel segments in patients with Crohn's disease requires a multiparametric approach, evaluating imaging features from several different pulse sequences. The most commonly used imaging features are well established in the literature for both CT scan [1][2][3][4] and MRI [5][6][7][8][9][10][11][12][13][14][15]. These include bowel wall thickening, bowel wall edema, perienteric edema and fluid, and mucosal, transmural, and possibly serosal hyperenhancement after intravenous contrast or gadolinium administration. With MRE, these Electronic supplementary material: The online version of this article

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“…CT enterography (CTE) is currently the most useful imaging test for the evaluation of patients with Crohn disease, although MR enterography shows promise and does not use ionizing radiation (5,6). CTE depicts not only the luminal narrowing of diseased bowel segments but also the mucosal or mural abnormalities and extraintestinal findings, such as fistulas or abscesses (7). CTE can be used to assess all segments of bowel in the abdomen and pelvis.…”

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confidence: 99%

Low-Dose ¹⁸F-FDG PET/CT Enterography: Improving on CT Enterography Assessment of Patients with Crohn Disease

Shyn¹,

Mortelé²,

Britz-Cunningham³

et al. 2010

J Nucl Med

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The purpose of this study was to evaluate the diagnostic efficacy of low-dose, combined 18 F-FDG PET/CT enterography (PET/CTE), compared with CT enterography (CTE) alone, in the assessment of patients with Crohn disease. Methods: Thirteen patients with Crohn disease were prospectively enrolled in this pilot study and underwent abdominal-pelvic 18 F-FDG PET/CTE using neutral oral and intravenous contrast medium. The effective dose from PET/CTE was 17.7 mSv for the first 4 patients and 8.31 mSv for the last 9 patients. Six patients underwent surgical resection of the bowel, and 7 patients underwent colonoscopy with biopsies within 27 d (mean, 12 d) of PET/CTE. PET/CTE and CTE images were each visually assessed for Crohn disease involvement in 54 bowel segments with pathology correlation. Extraintestinal findings were recorded. A CTE severity score, maximum standardized uptake value (SUVmax), SUVmax ratio, simplified endoscopic score, and clinical parameters were correlated with pathology inflammation grade, on a per-patient basis and on a per-bowel-segment basis, using Spearman correlation. Results: In 3 (23.1%) of 13 patients, 18 F-FDG uptake using PET/CTE revealed active inflammation in a bowel segment not evident using CTE (n 5 2) or revealed an enterocolic fistula missed with CTE (n 5 1). Visual interpretation of both PET/CTE and CTE images detected the presence of disease in all bowel segments with more than mild inflammation (sensitivity, 100%; specificity, 89.7%; positive predictive value, 78.9%; and negative predictive value, 100%). Correlation to inflammation grade per patient was the strongest for the SUVmax ratio (0.735, P 5 0.004) and SUVmax (0.67, P 5 0.013), as compared with the CTE score (0.62, P 5 0.024). Correlation with inflammation per bowel segment was higher for the CTE score (0.79, P , 0.0001) than the SUVmax ratio (0.62, P , 0.0001) or SUVmax (0.48, P , 0.0001). SUVmax correlated strongly with serum C-reactive protein (0.82, P 5 0.023), but CTE score did not. Conclusion: Low-dose 18 F-FDG PET/CTE, compared with CTE, may improve the detection and grading of active inflammation in patients with Crohn disease. PET/CTE also may reveal clinically significant findings, such as enterocolic fistula, not evident on PET or CTE alone.

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Active Crohn Disease: CT Findings and Interobserver Agreement for Enteric Phase CT Enterography

Abstract: At enteric phase CT enterography, jejunal attenuation is greater than ileal attenuation and collapsed bowel loops demonstrate greater attenuation than distended bowel loops. Mural hyperenhancement and increased mural thickness are the most sensitive CT findings of active Crohn disease.

Cited by 178 publications

References 26 publications

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

Low-Dose ¹⁸F-FDG PET/CT Enterography: Improving on CT Enterography Assessment of Patients with Crohn Disease

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Active Crohn Disease: CT Findings and Interobserver Agreement for Enteric Phase CT Enterography

Abstract: At enteric phase CT enterography, jejunal attenuation is greater than ileal attenuation and collapsed bowel loops demonstrate greater attenuation than distended bowel loops. Mural hyperenhancement and increased mural thickness are the most sensitive CT findings of active Crohn disease.

Cited by 178 publications

References 26 publications

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign

Low-Dose 18F-FDG PET/CT Enterography: Improving on CT Enterography Assessment of Patients with Crohn Disease

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Low-Dose ¹⁸F-FDG PET/CT Enterography: Improving on CT Enterography Assessment of Patients with Crohn Disease