Small bowel tuberculosis by multidetector CT enteroclysis

Ray, Dhirendra; Thukral, Brij Bhushan; Gupta, Rohini; Chintamani,; Prasad, Rajni

doi:10.1007/s11604-013-0220-x

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Ray D, et al (2013) observed a sensitivity of 93.75% for CT-EC in diagnosing small bowel tuberculosis. 16 Previous studies have demonstrated a sensitivity of more than 85% for CT-EC/CT-EG in detecting Crohn's disease. 17 The sensitivity of UGIE/ileo-colonoscopy for detecting bowel involvement in cases of intestinal tuberculosis and Crohn's disease in our study was 83.72% and 64.28% respectively.…”

Section: Comparison Of Incidence Of Associated Extra-intestinal Findimentioning

confidence: 98%

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Alpana¹,

Yadav²,

Yadav³

et al. 2019

jebmh

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BACKGROUND Intestinal tuberculosis is highly prevalent in India and the incidence of Crohn's disease is also increasing. Both these diseases have similar clinical presentation, imaging and pathological features. This makes differentiation between these two entities challenging. Differentiating these entities is important because there is a considerable difference in their management. CT enteroclysis (CT-EC) and CT enterography (CT-EG) are newer imaging techniques which provide good luminal distention of the bowel and allow better detection of bowel wall lesions, their pattern of enhancement and also detect extra-intestinal findings in the abdomen. The aim of this study was to evaluate the role of CT-EC/CT-EG in the detection, characterization and differentiation of intestinal tuberculosis and Crohn's disease. METHODS One hundred and fifty patients with clinically suspected intestinal tuberculosis or Crohn's diseases were subjected to CT-EC/CT-EG. Findings on CT-EC/CT-EG were correlated with other investigations (radiological, endoscopic, histopathological, microbiological, body fluid examination) and improvement on empirical therapy. RESULTS Seventy-nine patients had bowel lesions based on findings on CT-EC/CT-EG and other investigations of which 47, 18 and 14 patients had final diagnoses of intestinal tuberculosis, Crohn's disease and other bowel lesions (ulcerative colitis, duodenal ulcers, strictures of undetermined aetiology, parasitic infections and appendicitis) respectively. The sensitivity of CT-EC/CT-EG for detecting bowel involvement in intestinal tuberculosis and Crohn's disease was 91.48% and 94.44% respectively. Contiguous involvement of terminal ileum, ileo-cecal junction and adjacent colon, homogenous enhancement of bowel wall thickening, and abdominal lymphadenopathy were significantly more common in intestinal tuberculosis while jejunal involvement, mural stratification pattern of enhancement, strictures, skip lesions, mesenteric fat stranding and increased mesenteric vascularity were significantly commoner in Crohn's disease. Associated calcified and necrotic abdominal lymphadenopathy, cocoon formation and vertebral involvement were specific to intestinal tuberculosis. CONCLUSIONS CT-EC/CT-EG are sensitive investigations for detection of bowel lesions in intestinal tuberculosis and Crohn's disease. No site of bowel involvement or pattern of enhancement of bowel wall thickening is specific to intestinal tuberculosis or Crohn's disease. However, associated extra-intestinal findings on CT-EC/CT-EG and findings on other investigations can help differentiate between intestinal tuberculosis and Crohn's disease.

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Section: Comparison Of Incidence Of Associated Extra-intestinal Findimentioning

confidence: 98%

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Alpana¹,

Yadav²,

Yadav³

et al. 2019

jebmh

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“…The sensitivity of CTE to detect the bowel lesions is higher than that of ileocolonoscopy as the former not only demonstrates the extraintestinal findings but also permits complete evaluation of all bowel segments 33–37 . In our study, the sensitivity of diagnosing ITB/CD increased from 90.6 to 97.7% by combining findings on CTE with ileocolonoscopy, suggesting that all mucosal abnormalities cannot be delineated on CTE, and a combination of these two modalities increases the sensitivity of diagnosis.…”

Section: Discussionmentioning

confidence: 59%

Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital

Israrahmed

Yadav

et al. 2020

JGH Open

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Background and AimCrohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD.MethodsA total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed “CTE case record form” and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis.ResultsFinal diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel‐related diseases. The sensitivity of CTE (ITB vs CD, 90.2 vs 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB vs CD, 87 vs 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically (P < 0.001) seen in patients with CD, and necrotic (P = 0.002) and calcified (P = 0.055) lymph nodes were specifically seen in patients with ITB.ConclusionWe propose a systematic approach to the radiological differentiation of ITB from CD.

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“…In this study, the sensitivity of CT enterography for detecting CD and ITB was 78.65% and 75% respectively. Ray D et al [17] observed a sensitivity of 93.75% for CT enterography in diagnosing ITB. The sensitivity of CT enterography has been reported in excess of 85% for diagnosing CD [18][19][20][21].…”

Section: Discussionmentioning

confidence: 98%

“…Ray D et al . [ 17 ] observed a sensitivity of 93.75% for CT enterography in diagnosing ITB. The sensitivity of CT enterography has been reported in excess of 85% for diagnosing CD [ 18 - 21 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of CT enterography in the evaluation of ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy

Jehangir,

Parry,

Wani

et al. 2023

Pol J Radiol

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PurposeIleocolonoscopy aids in the diagnosis of ileocecal region pathologies when typical mucosal lesions are seen. However, in many cases the mucosal lesions of the ileocaecal region are atypical, rendering themselves to diagnostic dilemma. The present study aimed to study the role of computed tomography (CT) enterography in the evaluation of symptomatic patients who demonstrated ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy.Material and methodsSymptomatic patients who had ileocolonoscopy documented ileocecal mucosal lesions of uncertain diagnosis were enrolled. Patients were subjected to CT enterography within 10 days of ileocolonoscopy. On CT enterography a diagnosis of Crohn’s disease (CD) or ileocaecal tuberculosis (ITB) was made. The diagnosis obtained by CT enterography was correlated with the final diagnosis obtained from histopathology. Using descriptive statistics, the diagnostic performance of CT enterography was evaluated.ResultsA total of 153 cases were enrolled in the study. CT enterography findings were present in 147 cases, resulting in a diagnostic yield of 96%. Out of these, 58.16% (89/153) had CD, 26.14% (40/153) had ITB, 6.5% (10/153) had infectious ileitis, and 9.15% (14/153) were indeterminate on histopathology. CT enterography correctly identified 78.65% (70/89) of CD and 75% (30/40) of ITB. CT enterography had a sensitivity of 78.65% and 75%, specificity of 67.19% and 87.61%, positive predictive value of 76.92% and 68.18%, and diagnostic accuracy of 73.86% and 84.31% for diagnosing CD and ITB, respectively.ConclusionsCT enterography provided a high diagnostic yield in ileocaecal mucosal lesions of uncertain significance on endoscopy. CD and ITB were the predominant diseases detected in these individuals. CT enterography had a good diagnostic performance in the detection of these 2 disorders.

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Small bowel tuberculosis by multidetector CT enteroclysis

Abstract: Multidetector CT enteroclysis is well tolerable and accurate modality for evaluation and diagnostic characterization of small bowel tuberculosis.

Cited by 8 publications

References 10 publications

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Ct Enteroclysis / Ct Enterography for Differentiating Intestinal Tuberculosis From Crohn’s Disease

Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital

Diagnostic utility of CT enterography in the evaluation of ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy

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