Crohn Disease of the Small Bowel: Comparison of CT Enterography, MR Enterography, and Small-Bowel Follow-Through as Diagnostic Techniques
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 388-1 Poongnap2-Dong, Songpa-Gu, Seoul 138-040, Korea. Radiology
(Impact Factor: 6.87).
03/2009; 251(3):751-61. DOI: 10.1148/radiol.2513081184
To prospectively compare the accuracy of computed tomographic (CT) and magnetic resonance (MR) enterography and small-bowel follow-through (SBFT) examination for detection of active small-bowel inflammation and extraenteric complications in patients with Crohn disease (CD).
The institutional review board approved the study protocol; informed consent was obtained from all participants. Thirty-one consecutive patients who had CD or who were suspected of having CD underwent CT and MR enterography, SBFT, and ileocolonoscopy. Two independent readers reviewed CT and MR enterographic and SBFT images for presence of active terminal ileitis and extraenteric complications. Accuracy values of CT and MR enterography and SBFT for identification of active terminal ileitis were evaluated with the receiver operating characteristic method, with ileocolonoscopic findings as the reference standard. Sensitivity values of CT and MR enterography and SBFT for detection of extraenteric complications were compared by using the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards.
The study population included 30 patients (17 men, 13 women; mean age, 29.0 years) with CD. Differences in areas under the receiver operating characteristic curves for CT enterography (0.900 and 0.894), MR enterography (0.933 and 0.950), and SBFT (0.883 and 0.928) for readers 1 and 2, respectively, in the detection of active terminal ileitis were not significant (P > .017). Sensitivity values for detection of extraenteric complications were significantly higher for CT and MR enterography (100% for both) than they were for SBFT (32% for reader 1 and 37% for reader 2) (P < .001).
Because MR enterography has a diagnostic effectiveness comparable to that of CT enterography, this technique has potential to be used as a radiation-free alternative for evaluation of patients with CD.
Available from: PubMed Central
- "However, the efficacy of computed tomography enterography (CTE) or magnetic resonance enterography (MRE) is comparable to that of SBFT, so increased use of CTE and/or MRE is anticipated in the near future. A prospective Korean study reported that SBFT, CTE, and MRE appear to be equally accurate in identifying active inflammation in the small bowel . "
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ABSTRACT: The epidemiology, genetics, and clinical manifestations of Crohn's disease (CD) vary considerably among geographic areas and ethnic groups. Thus, identifying the characteristics of Korean CD is important for establishing management strategies appropriate for Korean patients. Since the mid-2000s, many studies have investigated the characteristic features of Korean CD. The incidence and prevalence rates of CD have been increasing rapidly in Korea, especially among the younger population. Unlike Western data, Korean CD shows a male predominance and a lower proportion of isolated colonic disease. Perianal lesions are more prevalent than in Western countries. Genome-wide association studies have confirmed that genetic variants in TNFSF15, IL-23R, and IRGM, but not ATG16L1, are associated with CD susceptibility in the Korean population. Studies of the associations between genetic mutations and the clinical course of CD are underway. Although it has been generally accepted that the clinical course of Korean CD is milder than that in Western countries, recent studies have shown a comparable rate of intestinal resection in Korean and Western CD patients. An ongoing nationwide, hospital-based cohort study is anticipated to provide valuable information on the natural history and prognosis of Korean CD in the near future.
Available from: Shinichi Hashimoto
- "Because of the young age of onset of Crohn's disease, CTE for this disease must be performed at an appropriate time. To help resolve this problem, the utility of MR enterography was reported as an alternative to CTE in the evaluation of young patients with Crohn's disease  "
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ABSTRACT: Aim. When determining therapeutic strategy, it is important to diagnose small intestinal lesions in Crohn's disease (CD) precisely and to evaluate mucosal healing as well as clinical remission in CD. The purpose of this study was to compare findings from computed tomographic enteroclysis/enterography (CTE) with those from the mucosal surface and to determine whether the state of mucosal healing can be determined by CTE. Materials and Methods. Of the patients who underwent CTE for CD, 39 patients were examined whose mucosal findings could be confirmed by colonoscopy, capsule endoscopy, balloon endoscopy, or with the resected surgical specimens. Results. According to the CTE findings, patients were determined to be in the active CD group (n = 31) or inactive CD group (n = 8). The proportion of previous surgery, clinical remission, stenosis, and CDAI score all showed significant difference between groups. Mucosal findings showed an association with ulcer in 93.6% of active group patients but in only 12.5% of inactive group patients (P < 0.0001), whereas mucosal healing was found in 62.5% of inactive group patients but in only 3.2% of active group patients (P < 0.0001). Conclusion. CTE appeared to be a useful diagnostic method for assessment of mucosal healing in Crohn's disease.
Available from: ncbi.nlm.nih.gov
- "Although the diagnostic yield of CTE has been shown to be inferior to SBCE in suspected and established SB CD,26 CTE have high sensitivities (95.2%) for detecting active SB inflammation. In addition, both CTE and MRE equally provide excellent information on extraenteric manifestations and complications including abscess, fistula, and bowel obstruction, thus adding useful information on endoscopic investigations.27 However, because patients with CD are often young and CD is a chronic and relapsing disease, they may undergo repeated imaging examinations to assess the status of their disease. "
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ABSTRACT: Crohn's disease (CD) is an inflammatory bowel disease that can affect the entire gastrointestinal tract, with the small bowel (SB) being the most commonly affected site. In some patients, refractory inflammation or chronic strictures of the SB are responsible for a debilitating course of the disease that might lead to severely reduced quality of life. Therefore, SB imaging is a crucial element in diagnosing and/or managing SB CD, and continues to evolve because of technologic advances. SB endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become key players to diagnose and/or manage CD. In everyday practice, the choice of the imaging modalities is based on the presence and availability of the techniques and of experienced operators in each institute, clinical usefulness, safety, and cost. Here, SB endoscopy and radiologic imaging in suspected or known CD patients will be addressed and discussed.
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