Computed Tomography Enterography Findings Research Articles

Residual abnormalities on CTE predict adverse outcomes in Crohn's disease with endoscopic healing

BackgroundResidual abnormalities on computed tomography enterography (CTE) in Crohn's disease (CD) with endoscopic healing (EH) may have prognostic implications and affect therapeutic strategy. MethodsCD patients with EH who underwent CTE between March 2015 and June 2022 were enrolled. CTE findings of the terminal ileum and the most severe segment of colon at the time of EH were assessed respectively for each patient. Cox regression analysis and Kaplan-Meier curves were used to evaluate the association between residual abnormalities and adverse outcomes. ResultsA total of 140 patients (217 digestive segments) were included. Mesenteric edema (hazard ratio [HR] = 3.61, 95% CI = 1.81–7.20, P<0.001), fibrofatty proliferation (HR = 3.40, 95% CI = 1.97–5.85, P<0.001) and active small bowel inflammation (HR = 2.74, 95% CI = 1.59–4.71, P<0.001) were risk factors for clinical relapse. Furthermore, we built a scoring system using the three parameters. Radiologic score ≥ 1 was the best threshold to predict clinical relapse (HR = 4.56, 95% CI = 2.54–8.19, P<0.001) and it was validated in different outcomes. ConclusionThe scoring system based on three residual abnormalities on CTE can predict adverse outcomes in CD patients with EH.

Computed tomography enterography predicts surgical-free survival in symptomatic stricturing Crohn's disease.

The study aimed to predict surgical risks for patients with symptomatic stricturing Crohn's disease (CD) using computed tomography enterography (CTE) and to assess the association between CTE findings and pathological changes. Crohn's disease patients with symptomatic stricture(s) were included. Exclusion criteria were concomitant penetrating disease, intra-abdominal abscess, previous bowel resection, or asymptomatic. Patients from January 2016 to December 2019 were identified as the primary cohort and those from January 2020 to June 2020 were identified as the validation cohort. Two independent experienced radiologists evaluated CTE variables including mucosal enhancement, mural stratification, wall enhancement, comb sign, lymphadenopathy, thick non-enhancing wall, bowel wall thickness, luminal diameter, and upstream lumen. Receiver operating characteristic, logistic regression, and nomogram were performed to identify the independent predictors of surgical-free survival. Histopathological scores of surgical specimens were also evaluated. 198 patients (primary cohort, 123 with surgery and 75 under non-surgical intervention, and 41 patients (validation cohort) were analyzed. Bowel wall thickness < 5.9mm, luminal stenosis > 3.35mm, and upstream lumen < 27.5mm were predictors of surgical-free survival for symptomatic stricturing CD patients. Logistic analysis showed the three CTE variables were the independent predictors of surgical-free survival (p < 0.001). A nomogram was developed with the concordance indexes of 0.905 and 0.892 in the primary and validation cohorts. Histopathological analysis showed bowel wall muscular hyperplasia/hypertrophy significantly correlated with luminal stenosis (r = - 0.655, p = 0.008) and combined CTE variable (r = - 0.683, p = 0.005). CTE is highly predictive of disease course and surgical-free survival for patients with symptomatic stricturing CD, suggesting the important role of CTE in decision-making of treatment.

Effectiveness and Power of Abdominal Ultrasonography in the Assessment of Crohn's Disease Activity: Comparison with Clinical, Endoscopic, and CT Enterography Findings.

Non-invasive methods play an important role in clinical assessment of Crohn's disease. Recent studies have highlighted the effectiveness and reliability of intestinal ultrasonography. We aimed to examine the relationship between intestinal ultrasonography and the clinical, endoscopic, and computed tomography enterography findings, and to assess the activity of Crohn's disease. This was a 1-year prospective study involving patients diagnosed with Crohn's Disease. Clinical and endoscopic activity indi- ces, and intestinal ultrasonography and computed tomography enterography findings were evaluated. Intestinal wall thickness, mes- enteric inflammation, lymphadenopathy, and complications were evaluated by intestinal ultrasonograpy and computed tomography enterography, while the superior mesenteric artery flow velocity, resistive index, and Limberg score were assessed by Doppler intestinal ultrasonography. Seventy-nine patients with Crohn's disease were included. A significant correlation was found between intestinal wall thick- ness, mesenteric inflammation, and complications in intestinal ultrasonography and computed tomography enterography (P = .0001). According to the receiver operating curve analysis, the intestinal wall thickness, and mesenteric inflammation were correlated with the Crohn's Disease Activity Index, Harvey-Bradshaw Index, and SES-CD scores (P < .05), and they were very effective in distinguishing active from inactive disease. According to the Crohn's Disease Activity Index and SES-CD scores, Doppler flow velocity of the superior mesenteric artery was significantly higher in the active group than in the inactive group (P < .05). The Limberg score was very consistent with the Crohn's Disease Activity Index, Harvey-Bradshaw Index , and the results of the Simple Endoscopic Score for Crohn's Disease (P < .0001). Our study showed that intestinal ultrasonography is an effective and reliable method for assessment of Crohn's disease activity compared to clinical, endoscopic, and CTE findings.

Computed Tomography Enterography Demonstrates Association to Histopathological Grading of Small Bowel Crohn’s Activity

Introduction: Crohn’s disease (CD) is a lifelong, progressive inflammatory condition of the bowel that adversely influences the quality of life. Diagnosis of CD can be challenging, as there is no trusted gold standard diagnostic procedure. Ileocolonoscopy cannot investigate the entire small bowel due to small bowel morphology. Multislice Computed Tomography (MSCT) improves small bowel imaging and has established a crucial role for Computed Tomography Enterography (CTE). Objective: This study investigated an association between CTE and histopathology in the evaluation of the activity of small bowel CD. Materials and Methods: A retrospective study was used to collect eligible cases. The sample size was a consecutive sampling of 98 patients with known CD. The patients underwent biopsy by ileocolonoscopy-guided retrograde terminal ileum intubation. Subjects were scanned with CTE for confirmation of the diagnosis, detection of complications, and further evaluation of CD. A Chi-Square test was performed to determine the association between CTE radiological pathological findings and CTE grading. Results: The peak prevalence of Crohn’s activity occurred between the ages of 20–30 years. Definitive clinical presentations of CD include diarrhea, abdominal pain, and weight loss, frequently followed by a chronic deteriorating progression, with distinct variations in the type and severity of symptoms. Fisher exact test showed that there is a statistically significant association between radiological pathological findings of CTE and CTE diagnostic grading of CD (0.05, 2-sided). Moreover, there is a relationship between radiological pathological findings of CTE and histopathological findings. Conclusions: The CTE radiological pathological findings demonstrate an association with the histopathological findings of CD. The CTE findings may be helpful for the differential diagnosis and planning of treatment strategy.

Computed tomography enterography for crohn's disease: correlation between the imaging findings and histopathologic scoring system.

The aim of this study was to retrospectively determine if quantitative measurements of computed tomography enterography (CTE) imaging findings correlate with histopathologic scores from biopsy specimens in patients with Crohn's disease (CD). CTE datasets of 34 CD patients (19 male and 15 female) who underwent endoscopy with biopsy within 25 days before or after CTE were retrospectively reviewed. CTE findings of segmental mural hyperenhancement, wall thickening, mural stratification and mesenteric findings were quantitatively measured in the corresponding segment. Histopathologic score of CD was based upon the Naini Cortina scoring system. Correlation between CTE findings and histopathologic scores was assessed using Spearman's rank correlation and logistic or linear regression analysis. Neutrophilic inflammation contributed the most to the segmental mural hyperenhancement and explained 38.4% of the variance (R2 = 0.384, P = 0.006). Moreover, the increased lymphocytes and plasma cells predicted larger lymph node (P = 0.003) and increased attenuation in mesenteric fat (P = 0.022). To a certain extent, macroscopic CTE findings may reflect the microscopic histopathologic state in the inflammatory stage of CD, underscoring that establishment of CTE scoring system may potentially provide an objective tool for assessment of disease progression.

Crohn's disease: A retrospective analysis between computed tomography enterography, colonoscopy, and histopathology

IntroductionTo investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers. MethodsHospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens’ kappa analyses were performed. ResultsThe CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86). ConclusionCTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.

P229 The relationship between computed tomography enterography findings and levels of faecal biomarkers in patients with small bowel Crohn’s disease: A prospective study

P229 The relationship between computed tomography enterography findings and levels of faecal biomarkers in patients with small bowel Crohn’s disease: A prospective study

Monitoring Crohn's disease activity: endoscopy, fecal markers and computed tomography enterography.

Background:The treatment goal of Crohn’s disease (CD) has moved towards achieving mucosal healing, resolution of transmural inflammation, and normalization of biomarkers. The purpose of this study was to evaluate how well computed tomography enterography (CTE) and fecal calprotectin (FC) correlated with endoscopic activity in newly diagnosed patients with CD and after 1 year of therapy.Methods:Consecutive patients with newly diagnosed CD were evaluated by endoscopy, CTE, and FC at diagnosis and 12 months after beginning immunosuppression. Endoscopic severity was assessed using the Simplified Endoscopic Score for Crohn’s Disease (SES-CD). Biomarkers, clinical indexes, and FC were recorded on the day of ileocolonoscopy at diagnosis and 1 year after diagnosis. We adapted a CTE score for disease activity based on radiological signs of inflammation (i.e. mural thickness, mural hyperenhancement, mesenteric fat proliferation, mesenteric fat densification, comb sign, presence of strictures, fistulas, abscesses, ascites, and lymphadenopathy). Correlations between endoscopy, CTE, and FC were assessed using Spearman’s rank correlation.Results:A total of 29 patients (48% women; median age 30 (24.5–35.5) years) were included in this prospective cohort. CTE findings significantly correlated with endoscopic findings. Endoscopic remission (ER) at 1-year follow up significantly correlated with improvement in mural hyperenhancement (p = 0.004), mesenteric fat densification (p = 0.001), comb sign (p = 0.004), and strictures (p = 0.008) in CTE. None of the CTE findings improved in patients without ER. FC correlated with SES-CD (rs = 0.696, p < 0.001) and with CTE features of inflammation (rs = 0.596, p < 0.001). A cut-off of 100 µg/g predicted ER with 92% sensitivity, 65% specificity, and 83% accuracy (area under curve 0.878, p < 0.001).Conclusions:CTE findings and FC levels correlated with endoscopic activity in CD both at diagnosis and at 1-year follow up. These two noninvasive markers of disease activity may be used as an alternative to endoscopy to monitor disease response to therapy.

Optimizing the Diagnostic Yield and Clinical Impact of Computed Tomography Enterography for Patients With Obscure Gastrointestinal Bleeds

Introduction: Computed tomography enterography (CTE) and capsule endoscopy (CE) are commonly performed to investigate obscure gastrointestinal bleeds (OGIB). CE is suggested as the first-line investigation of OGIB as it has been shown to have a superior diagnostic yield. However, CTE is more available and less expensive compared to CE. Despite evidence that CTE may be more accurate for identifying some lesions such as masses and strictures, patient selection to optimize the clinical impact of CTE has not been previously examined. This study sought to determine the diagnostic yield of CTE in OGIB, investigate characteristics associated with positive CTE, and examine clinical outcomes in patients with a positive CTE. Methods: We performed a retrospective cohort study on patients who underwent CTE from The Ottawa Hospital between 2005- 2015. Patient demographics, clinical presentation, prior investigations, post-CTE interventions and treatment outcomes were collected by chart review. All variables were selected a priori from literature review. Results: CTE was diagnostic in 52 (19%) of 274 OGIB cases. Patients with a positive CTE (mean age 65 years, range 25-88 years, 50% female) had an average presenting Hb of 87 g/L, ferritin 66 μL and iron 8 μmol/L. 40 (77%) of the diagnostic findings included intestinal wall thickening (40%), angiodysplasias (27%), bowel mass (17%), and/or stricture (6%). 27 patients (52%) presented with at least one of the following symptoms in addition to OGIB: nausea, abdominal pain, fatigue and weight loss. 13/52 (25%) patients had specific interventions done to address lesions found on the CTE. 5 patients underwent endoscopic hemostasis, 3 patients underwent bowel resection, 1 patient required vessel embolization, and 3 were treated for inflammatory bowel disease. These patients were also more likely to re-bleed, have ongoing anemia and be re-hospitalized for gastrointestinal bleeding. Conclusion: CTE may be diagnostic in 1 in 5 cases of OGIB, potentially avoiding the need for CE in these cases. The diagnostic yield may be even greater for patients who present with abdominal and/or constitutional symptoms. Patients who required specific interventions after a diagnostic CTE had a greater propensity for re-bleeding, suggesting that early interventions after positive CTE findings patients may result in better outcomes. Further research is needed to delineate the patient population most likely to benefit from CTE evaluation prior to or instead of CE for OGIB.

Imaging features of surgical complications of Crohn′s disease

Imaging features of surgical complications of Crohn′s disease

Su1785 Faecal Calprotectin Level Correlates Well With Balloon Assisted Endoscopy and Computed Tomography Enterography Findings in the Small Bowel Crohn's Disease Patients

Su1785 Faecal Calprotectin Level Correlates Well With Balloon Assisted Endoscopy and Computed Tomography Enterography Findings in the Small Bowel Crohn's Disease Patients

P198. Faecal calprotectin level correlates well with balloon-assisted endoscopy and computed tomography enterography findings in small bowel Crohn’s disease

P198. Faecal calprotectin level correlates well with balloon-assisted endoscopy and computed tomography enterography findings in small bowel Crohn’s disease

Role of Multi-Detector CT in Assessment of Patients Suspected with Chronic Inflammatory Bowel Disease

Background:Crohn’s disease and ulcerative colitis evolve with a relapsing and remitting course. Determination of inflammatory state is crucial for the assessment of disease activity and for tailoring therapy .Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extra intestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality

Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease

Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality.

Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohnʼs disease

It has become commonplace to categorize small intestinal Crohn's disease (CD) as "active" vs. "inactive" or "inflammatory" vs. "fibrotic" based on computed tomography enterography (CTE) findings. Data on histologic correlates of CTE findings are lacking. We aimed to compare CTE findings with histology from surgically resected specimens. We tested the hypothesis that CTE findings can distinguish tissue inflammation from fibrosis. Patients who underwent CTE within 3 months before intestinal resection for CD were retrospectively studied. Radiologists blinded to history and histology scored findings on CTE. Pathologists blinded to history and imaging scored resected histology. We compared histology with CTE findings and radiologists assessment of whether the stricture was likely "active" or "inactive." In all, 22 patients met inclusion criteria. Inflammatory CTE findings correlated with histologic inflammation (rho = 0.52). Strictures believed to be "active" on CTE were more inflamed at histology (P = 0.0002). Strictures lacking inflammatory findings on CTE or considered "inactive" were not associated with greater histologic fibrosis or significant histologic inflammation. Upstream dilation was associated with greater tissue fibrosis in univariate (P = 0.014) but not in multivariate analysis (P = 0.53). Overall, histologic fibrosis correlated best with histologic inflammation (rho = 0.52). Strictures on CTE with the most active disease activity also had the most fibrosis on histology. CTE findings of mesenteric hypervascularity, mucosal hyperenhancement, and mesenteric fat stranding predict tissue inflammation. However, small bowel stricture without CTE findings of inflammation does not predict the presence of tissue fibrosis. Therefore, caution should be used when using CTE criteria to predict the presence of scar tissue.

Long‐term outcomes of obscure gastrointestinal bleeding after CT enterography: Does negative CT enterography predict lower long‐term rebleeding rate?

Computed tomography enterography (CTE) is a promising modality for small bowel imaging. However, the role of CTE in the evaluation of obscure gastrointestinal bleeding (OGIB) has not been established. We investigated the efficacy of CTE in diagnosing OGIB and the long-term outcomes based on CTE findings, with special reference to negative CTE. A total of 63 consecutive patients who had undergone CTE for OGIB were enrolled, and their pre- and post-CTE clinical data were collected. "Specific treatments" were defined as treatments directly aimed at resolving presumed bleeding causes, including hemostasis and operation, while "non-specific treatments" were defined as symptomatic treatments for anemia. Among 60 patients for whom long-term follow-up data were available, positive lesions were found in 16 patients (26.7%). The overall rebleeding rate was 21.7% during a mean follow up of 17.6 ± 4.7 months. There was no significant difference in the cumulative rebleeding rates between patients with positive and negative CTE results (P = 0.241). All patients who received specific treatments after CTE did not rebleed (0/8). In positive CTE patients, specific treatments significantly reduced the rebleeding rate (P = 0.023). CTE has a high rate of detecting overt OGIB. However, negative CTE results do not predict lower long-term rebleeding, and such patients with OGIB should be closely observed. In patients with positive CTE, more vigorous management significantly reduces the incidence of rebleeding.

Validation of a lower radiation computed tomography enterography imaging protocol to detect Crohnʼs disease in the small bowel

The purpose was to validate a lower radiation dose computed tomography enterography (CTE) imaging protocol to detect the presence of Crohn's disease (CD) in the small bowel using two different reference standards and to identify a prediction model based on CTE signs for the presence of active CD. This retrospective study included patients with known or suspected CD who underwent CTE between January and October 2006 according to a lower radiation dose protocol. Two gastrointestinal radiologists blindly and independently classified each CTE as being active or inactive. Reference standards included ileocolonoscopy ± biopsy and a comprehensive clinical reference standard (retrospectively created by a gastroenterologist, also including history, physical, follow-up course, and subsequent endoscopy, imaging, or surgery). Logistic regression was used to identify CTE findings that predicted the presence of active CD based on the combined clinical reference standard. In all, 137 patients underwent CTE and ileocolonoscopy. Using an endoscopic reference standard, the sensitivity of CTE to detect active CD for the two readers was 81% and 89%, respectively. Using the clinical reference standard, the sensitivity of CTE to detect active CD was 89% and 98%, respectively. For both readers the sensitivity of CTE increased by 8%-9% when using the comprehensive reference standard. Multivariate analysis showed that a combination of mural thickness and hyperenhancement best predicted active CD (area under the curve [AUC] = 0.92-0.93, P < 0.0001). Lower radiation dose CTE exams are sensitive for the detection of active small bowel CD. The combination of mural thickness and hyperenhancement are the best radiologic predictors of active CD.