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

Abstract

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.

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

“…CT enterography offers the advantage of noninvasively assessing the entire bowel and extra-intestinal abnormalities and aids in differentiating between CD and ITB. On imaging, long segment discontinuous gut involvement, mesenteric hypervascularity are common in CD, whereas contiguous bowel involvement and presence of necrotic mesenteric lymph nodes favours ITB [12][13][14][15][16]. This study evaluated the role of CT enterography in the evaluation of ileocecal mucosal lesions of uncertain diagnosis on ileocolonoscopy.…”

“…The findings were noted, and a diagnosis of CD and ITB was made on CT using the established imaging features already described in the literature [ 13 , 14 ]. A diagnosis of CD was made when typical imaging findings like symmetrical bowel wall thickening, mucosal hyper enhancement with stratified bowel wall appearance, discontinuous bowel wall involvement, terminal ileum predominance, comb sign, and small enhancing mesenteric nodes were detected.…”

Differentiation of intestinal tuberculosis and Crohn’s disease through an explainable machine learning method

“…Many researchers have been established several models to address this issue by using the clinical symptoms, laboratory tests, endoscopic findings and so on 3 , 9 – 12 , 40 . Israrahmed et al conduct a prospective study, which proposed multiple variables to arrive at the final diagnosis of CD and ITB 41 . Especially, Kim et al develop a deep-learning system for differentiation between Crohn’s disease, intestinal Behcet’s disease (BD) and intestinal tuberculosis using 6617 colonoscopy images of 211 CD, 299 BD and 217 ITB patients 42 .…”