Computed tomography enterography or magnetic resonance enterography in Crohn's disease - which to choose? / Enterografia por tomografia computadorizada ou por ressonância magnética na doença de Crohn - qual escolher?

ABSTRACT Rationale and objectives: Evaluation of Crohn's disease by computed tomography enterography, magnetic resonance imaging enterography and colonoscopy is essential for disease monitoring. The aim of this study is to evaluate this exams acuity. Materials and methods: Patients with histological diagnosis of Crohn's disease who underwent computed tomography enterography, magnetic resonance imaging enterography and colonoscopy in the period of January 1st, 2009 and July 31st, 2016 and the realization of these exams did not exceed a time interval of 6 months was included. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), Cohen's kappa (K), agreement and disagreement were calculated. Results: Comparing computed tomography enterography and magnetic resonance imaging enterography with colonoscopy, there was an agreement of 85.7% and a disagreement of 14.3% in Crohn's disease overall detection, for both exams. Computed tomography enterography and colonoscopy showed greater agreement in abscesses and lumen reduction detection (C = 95.2%) and magnetic resonance imaging enterography and colonoscopy in abscesses detection (C = 92.9%). Comparing magnetic resonance imaging enterography and computed tomography enterography, greater agreement was observed in detection of lumen reduction/dilatation (C = 96%). K showed considerable agreement in detection of mesenteric lymph nodes, fistulas, mural inflammation and thickening. The sensitivity, specificity, PPV and NPV were respectively set at 94.12% (95% CI 71.31-99.85), 50% (95% CI 6.76-93.24), 88.89% (95% CI 65.29-98.62) and 66.67% (95% CI 9.43-99.16) for CTE and 90.62% (95% CI 80.70-96.48), 33.33% (95% CI 4.33-77.72), 93.55% (95% CI 84.30-98.21) and 25% (95% CI 3.19-65.09) for MRIE. Conclusions: Although computed tomography enterography presents better sensitivity and specificity than magnetic resonance imaging enterography, both present high agreement values in detection of characteristic Crohn's disease findings, therefore the selection of the best test to monitor Crohn's disease should take into account aspects such as age, tolerability, disease phenotype and resources availability.

RESUMO Fundamentação e objetivos: A avaliação da doença de Crohn por enterografia por tomografia computadorizada, enterografia por ressonância magnética e colonoscopia é essencial para o monitoramento da doença. Este estudo teve como objetivo avaliar a acuidade desses exames. Materiais e métodos: O estudo incluiu pacientes com diagnóstico histológico de doença de Crohn submetidos à enterografia por tomografia computadorizada, enterografia por ressonância magnética e colonoscopia no período entre 1° de janeiro de 2009 e 31 de julho de 2016; os exames foram realizados em um intervalo de máximo de seis meses. Calculou-se a sensibilidade, especificidade, valores preditivos positivo e negativo (VPP, VPN), Kappa (K) de Cohen, concordância e discordância. Resultados: Ao comparar enterografia por tomografia computadorizada e enterografia por ressonância magnética com colonoscopia, observou-se uma concordância de 85,7% e discordância de 14,3% na detecção global da doença de Crohn para ambos os exames. A enterografia por tomografia computadorizada e a colonoscopia mostraram maior concordância nos abscessos e na detecção da redução da luz (C = 95,2%) e enterografia por ressonância magnética e colonoscopia, na detecção de abscessos (C = 92,9%). Ao comparar a enterografia por ressonância magnética e a enterografia por tomografia computadorizada, observou-se maior concordância na detecção da redução/dilatação do lúmen (C = 96%). Os valores de K mostraram concordância considerável na detecção de linfonodos mesentéricos, fístulas, inflamação e espessamento mural. A sensibilidade, especificidade, VPP e VPN foram, respectivamente, 94,12% (IC 95%: 71,31 ± 99,85), 50% (IC 95%: 6,76 ± 93,24), 88,89% (IC 95%: 65,29 ± 98,62) e 66,67% (IC 95%: 9,43 ± 99,16) para ETC e 90,62% (IC 95%: 80,70 ± 96,48), 33,33% (IC 95%: 4,33 ± 77,72), 93,55% (IC 95%: 84,30 ± 98,21) e 25% (IC 95%: 3,19 ± 65,09) para enterografia por ressonância magnética. Conclusões: Embora a enterografia por tomografia computadorizada apresente melhor sensibilidade e especificidade que a enterografia por ressonância magnética, ambas apresentam altos valores de concordância na detecção dos achados característicos da doença de Crohn. Assim, a seleção do teste mais adequado para monitorar a doença de Crohn deve levar em consideração aspectos como idade, tolerabilidade, fenótipo da doença e disponibilidade de recursos.

Logistic regression analysis of CT enterography evaluation on the activity of Crohn's disease / 实用放射学杂志

Objective To evaluate the CT enterography(CTE)of Crohn's disease (CD)in active state and catabatic state by using the Logistic regression analysis.Methods 6 2 patients with CD diagnosed by clinic,imaging,endoscopy,surgery or pathology were analyzed retrospectively.The CTE features of CD in active state and catabatic state were recorded and compared by using single factor and multiple stepwise Logistic regression analysis,and the Logistic regression model was established.Results There were 62 patients with CD, including 40 in active state and 22 in catabatic state.There were significant differences between the bowel wall thickness,the CT value in arterial phase as well as in portal venous phase,the type of enhancement pattern,pseudodiverticulum of free margin,increased mesenteric fat density,comb sign,enlarged abdominal lymph nodes and cellulitis in active state and those in catabatic state of CD by using single factor analysis (P<0.05).The bowel wall thickness (OR=4.589,95%CI:1.689-11.822),bowel wall uniformity enhancement (OR=0.006, 95%CI:0.001-0.067 )and comb sign(OR=23.112,95%CI:1.707-312.997)were significant features by using Logistic regression analysis. Conclusion The bowel wall thickness,bowel wall uniformity enhancement and comb sign are the independent characteristic CTE features to predict the CD in active state or in catabatic state.The Logistic regression model is helpful in demonstrating the state of CD.

Clinical application of MDCTE score in evaluating Crohn's disease Activity / 安徽医科大学学报

Fifty activity small intestinal Crohn's disease patients were enrolled in this study.Every patient was confirmed multidetector CT enterography (MDCTE) scanning.The CT imaging and scored accoeding to the CT findings were retrospectively analyzed.Patients were divided into mild,moderate,severe activities according to patients'Crohn's disease activity index(CDAI).The correlation between CT score and the CDAI was compared.Results showed that CT score and CDAI had significant correlation (r =0.825,P ＜ 0.825).The MDCTE score can be used for clinical evaluation of Crohn's disease activity.

Modalidades de imagen en la evaluación de enfermedad inflamatoria intestinal / Imaging techniques in the evaluation of inflammatory bowel disease

La enfermedad inflamatoria intestinal es una patología crónica, con una incidencia cada vez mayor. Dentro de este grupo de afecciones, la enfermedad de Crohn y la colitis ulcerosa son las más frecuentes. La enterografía por tomografía computada (ETC) y por resonancia magnética (ERM) son las modalidades de elección para la evaluación y seguimiento de la entidad, permitiendo examinar la apariencia de la mucosa, la pared intestinal, las manifestaciones extraintestinales y las complicaciones asociadas. La elección del estudio debe hacerse de acuerdo con la condición clínica de cada paciente

Inflammatory bowel disease is a chronic condition with increasing incidence. Crohn's disease and ulcerative colitis are the most common pathologies. Computed tomography (CT) enterography and magnetic resonance (MR) enterography are the methods of choice for evaluating and monitoring this entity, assessing the appearance of intestinal wall, mucosa, extra-intestinal manifestations, and associated complications. The preferred imaging methods must be selected according to the clinical conditions of the patient

The analysis for images of multi-slice spiral CTE performance levels in active ulcerative ;colitis / 中国医学装备

Objective: To investigate the imaging characteristics of the intestinal multi-slice spiral CT enterography (CTE) in active ulcerative colitis(UC), analyze and summarize its application value. Methods: A total 43 cases diagnosed with active UC from April 2014 to April 2015 in our hospital were selected and divided into mild, moderate and severe three levels with each level as a group, treated by multi-slice spiral CTE examination system based on the improved Mayo system, comparing different performances of CTE levels. Results:43 cases of UC patients participating in the study, eight patients were mild, 16 cases were moderate and 19 cases were severe. There was statistically different in the intestinal mucosa in the presence of air bubbles between the mild and moderate group (x2=21.62; P0.05). Conclusion:UC patients CTE examination, which can effectively conduct a comprehensive assessment against bowel, intestinal and parenteral, provide favorable conditions for the activity of UC clinical diagnosis and classification.

Magnetic resonance enterography for the evaluation of the deep small intestine in Crohn's disease

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.

La Tomografía Computarizada en la evaluación de la afección inflamatoria intestinal / Computed Tomography in the assessment of inflammatory bowel disease

Introducción: las técnicas de imagen tienen un importante papel en el diagnóstico de la enfermedad inflamatoria intestinal constituyendo la Tomografía Computarizada una técnica novedosa por su amplia perspectiva. Objetivos: describir la importancia de la Tomografía Computarizada en la valoración de la enfermedad inflamatoria intestinal e identificar los principales signos tomográficos de esta condición mediante la caracterización de la Enfermedad de Crohn. Material y Métodos: se realizó una búsqueda bibliográfica automatizada consultando las bases de datos de sistemas MEDLINE (motor de búsqueda PubMed) seleccionando aquellas más recientes y de mayor relevancia, preferentemente publicadas en el período del 2007 al 2012 utilizando como descriptores: enterografía por Tomografía Computarizada, enteroclisis por Tomografía Computarizada y Enfermedad de Crohn. Posteriormente, tras un proceso de análisis y síntesis se realizó la redacción del artículo. Desarrollo: se efectúa enfoque comparativo de las principales técnicas por imagen utilizadas en la enfermedad inflamatoria intestinal resaltando la utilidad de la Tomografía Computarizada en la valoración de la pared y lesiones extraluminales asociadas. Además son enunciados los principales hallazgos tomográficos en el diagnóstico, evolución y complicaciones de las mismas teniendo como entidad tipo la Enfermedad de Crohn. Conclusiones: la Tomografía Computarizada constituye una técnica novedosa en la valoración de la enfermedad inflamatoria intestinal, al superar las técnicas convencionales. Además nuevas generaciones de tomógrafos multicorte permitirán mejor valoración de los cambios morfológicos estructurales.

Introduction: image techniques play an important role in the diagnosis of inflammatory bowel diseases and computerized tomography constitutes a novel technique due to its wide scope. Objectives: to describe the importance of computed tomography in the assessment of inflammatory bowel disease and identify the tomographic findings by means of characterising features of Crohn´s disease. Material and Methods: it was made a review through automatized data base MEDLINE (PubMed as search engine) using computed tomography enterography, computed tomography enteroclysis and Crohn´s disease as descriptors. The review was based on the critical analysis of relevant publications, most appearing from 2007 to 2012 . Development: in the present revision article, we carried out a comparative approach of the main imaging techniques used in the inflammatory bowel disease pointing out the usefulness of computed tomography to evaluate the wall and extraluminal lesions and the main tomographic findings in the diagnosis, evolution and their complications were stated taking the Crohn´s disease as an entity type. Conclusions: computed tomography is a novel imaging study in the assessment of inflammatory bowel disease which goes beyond conventional imaging investigations. New generations of multislice computed tomography may provide a better assessment of structural morphologic changes.

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.

A Look into the Small Bowel in Crohn's Disease

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.