The potential role of CT enterography and gastrointestinal ultrasound in the evaluation of anti-tubercular therapy response of intestinal tuberculosis: a retrospective study

Abstract

Background Accurate evaluation of anti-tubercular therapy (ATT) responses is crucial for both diagnosis and treatment of intestinal tuberculosis (ITB). Little is known about the role of cross-sectional imaging techniques in ITB follow-up assessment. We aimed to investigate the accuracy of cross-sectional imaging modalities, CT enterography (CTE) and gastrointestinal ultrasound (GIUS), in the evaluation of ATT responses in ITB patients. Methods Patients diagnosed with ITB and followed up by CTE and/or GIUS were retrospectively searched in the databases. Clinical, imaging, laboratory and endoscopic data were collected at baseline and the first follow-up visit. Responses were graded as good, partial and no response based on protocols described in the literature and by our institution. CTE evaluation was based on changes in the lesion area, mural thickness, enhancement patterns and lymph nodes, while GIUS evaluation was based on changes in bowel wall morphology and the Limberg score. Clinical evaluation was used as the gold-standard evaluation method, which was determined by a comprehensive impression of endoscopic changes along with symptomatic improvement and laboratory tests, with imaging results masked. Results Twenty patients with ITB were enrolled in our study. The first follow-up time was from 2 to 12 months (average 6 months). According to the gold standard evaluation, 11 patients were evaluated as having a good ATT response, while 9 had a partial response. A total of 18 patients were followed up by CTE, while 7 were followed up by GIUS, depending on medical and/or financial considerations. The accuracy of CTE and GIUS was 83% (15/18) and 85.7% (6/7), respectively. The sensitivity, specificity, PPV and NPV of CTE were 88.9, 77.8, 80 and 87.5%, respectively. Moreover, the sensitivity, specificity, PPV and NPV of GIUS were 100, 50, 83.3 and 100%, respectively. By combining the results of CTE and GIUS results, the overall accuracy was 90%, with sensitivity and specificity of 91.7 and 87.5%, respectively. Conclusion To our knowledge, this is the first study exploring the accuracy of the cross-sectional imaging modalities CTE/GIUS in the evaluation of ATT responses. Our results indicated their promising application prospect in clinical practice as a non-invasive and cost-effective approach. Electronic supplementary material The online version of this article (10.1186/s12876-019-1030-0) contains supplementary material, which is available to authorized users.

Distinct Sonographic Features of Intestinal Tuberculosis

“…5 Ma et al recently used abdominal ultrasound for following up patients with intestinal tuberculosis and monitoring the response to anti-tuberculous medications. 8 Our case presented with a distinctive bowel wall thickening regularly spaced by echogenic foci giving it a distinctive appearance that resembling a 'rosette.' We think that this appearance might represent an enlarged lymphoid tissue within the mucosa that is most clearly seen at the right iliac fossa, which made us propose that they might represent an enlarged payer's patches given the fact that predominant ileocecal involvement of intestinal TB is well known.…”

CT Appearances in Treated Abdominal Tuberculosis: A Radiologist's Dilemma

“…Although TB is a benign disease, cecal wall thickening was found to be asymmetrical in treated abdominal TB, probably because there is unsynchronized healing of the bowel wall in ulcerative, hypertrophic, and ulcerohypertrophic types of TB. 11 Pericecal fat stranding, present in 20% cases, apparently does not indicate active inflammation.…”

“…Ma et al also opined that abnormal bowel wall contrast enhancement persisted in 4/14 patients after ATT, although HU have not been mentioned in their article. 11…”

“…Ma et al observed that necrotic nodes persisted after ATT, but there was a significant decrease in enlarged mesenteric nodes. 11…”

“…Although there are innumerable studies in literature on sonographic [1][2][3] and CT appearances 1,4,5 in abdominal TB, there is paucity of literature regarding CT appearances in healed abdominal TB, [6][7][8][9][10] and it is mostly anecdotal. Ma et al 11 have explored the roles of CT enterography and gastrointestinal ultrasound in the evaluation of ATT response to intestinal TB retrospectively.…”