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

Abstract

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. 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 (C-reactive 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. 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). 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.