Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease.

INTRODUCTION: During the last few decades introducing many of new radiologic methods, diagnostic conditions and facilities of Crohn's disease has became markedly improved. Appropriate using of these technics definitely modifies the management of patients with known or suspected Crohn's disease serving reliable information about extent, severity and possible complications of disease. Enteroclysis and Computed tomography are the two major and basic methods to disclose or confirme diagnosis of Crohn's disease, obtain appropriate inforination about disease either with mucosal, transmural or extraintestinal manifestation. METHODS AND PATIENTS: We evaluated 281 patients who were referred in our institution under suspition of Crohn's disease. Enteroclysis and abdominal spiral CT in all cases were carried out usually within 1 week. The 172 patients underwent abdominal spiral CT as the primary examination to evaluate diagnostic value of spiral CT in this entity, while 109 patiens had enteroclysis followed by abdominal CT. In 11 cases we also perforined CT enteroclysis with administration of 0.5% methylcellulose solution thorough nasojejunal tube controlled by electric motor driven contrast pump. Results were compared with final clinical, pathological or surgical data were available. RESULTS: From the 281 patients eventually 74 proved Crohn's disease; sensitivity and specificity of enteroclysis proved to be 96 and 98%, while spiral CT sensitivity and specificity was 94 and 95%, respectively. Enteroclysis was superior to the spiral CT in demonstration of early lesions and functional disorders, while spiral CT proved to be essential in evaluation of transmural and extraintestinal complications. CONCLUSIONS: Regarding enteroclysis and spiral CT as complementary methods, they provide excellent results in diagnosis of Crohn's disease.

Ultrasound in Crohn's disease of the small bowel.

OBJECTIVE: The purpose of this work is to prospectively evaluate high resolution ultrasonography with graded compression in the ability to detect Crohn's disease of the small bowel (CDSB) together with its complications and activity signs, compared with enteroclysis, CT and immunoscintigraphy in the mirror of the final diagnosis. METHODS AND MATERIAL: In a series of 73 consecutive patients, who were referred for enteroclysis with suspected Crohn's disease of the small bowel computed tomography (CT), ultrasound (US), immunoscintigraphy with 99mTc labeled monoclonal antigranulocyte antibody (AGAb) examinations were performed within 10 days from each other. For the final evaluation the diagnosis of CDSB was based on combination of clinical and enteroclysis findings (73 cases) and in 17 cases additional surgical and pathological data were available. The results of other modalities were blinded to the radiologists performing and reading out the exams. The diagnostic values of each modality was assessed also in those 18 patients, who had early Crohn's disease. In the group of 43 patients with proven CDSB who had all the four imaging modalities, the modalities were compared in their ability to demonstrate various pathological conditions related to CD. Increased (>500 ml/min) flow measured by Doppler US in the superior mesenteric artery and increased color signs in the gut wall seen by power Doppler sonography were compared to CDAI. RESULTS: Of the 73 patients the combination of enteroclysis and clinical tests demonstrated CDSB in 47. The sensitivity, specificity and accuracy of ultrasound were 88.4, 93.3 and 90.4%, respectively. Enteroclysis was the most accurate method. CT was more sensitive than US, but less specific. The accuracy of US, CT and scintigraphy were similar. In the group of 18 patients, who had early CDSB, the sensitivity of US decreased to only 67%, CT and scintigraphy had higher values. Intra- and perimural abscesses, and sinus tracts were also more frequently visualized by US, especially if they were small. US was superior than CT in detecting stenoses and skip lesions, but inferior to enteroclysis. US and CT detected more fistulas, than enteroclysis. Compared to CT, US detected more cases with mesenteric lymphadenopathy, equal cases with abscesses and free peritoneal fluids. In detecting mesenteric inflammatory proliferation CT, and in detecting colonic involvement CT and immunoscintigraphy were slightly superior than graded compression US. Patterns of mural stratification detected by ultrasound correlated well with the enteroclysis severity stages. There was only 59% agreement between increased superior mesenteric artery flow detected by Doppler sonography and CDAI, and 60.5% agreement between increased number of Color pixels in the gut wall measured by power Doppler and increased CDAI. CONCLUSION: High resolution graded compression sonography is a valuable tool for detecting small intestinal Crohn's disease. It has similar diagnostic values as CT. However in early disease the sensitivity substantially decreases. In known Crohn's disease for following disease course, evaluating relapses and extramural manifestations US is an excellent tool. Doppler and Power Doppler activity measurements do not correlate well with the more widespread clinical activity index.

Spiral CT colonography in inflammatory bowel disease.

OBJECTIVE: Most of the studies on virtual colonoscopy are dealing with the role of detecting colorectal polyps or neoplasms. We have undertaken this study to evaluate the value of CT colonography in patients with colonic Crohn's disease. METHODS AND MATERIAL: Five patients (three males, two females, 23-51 years, mean age 42 years) with known (4) or suspected (1) Crohn's disease of the colon underwent fiberoptic colonoscopy and CT colonography in the same day or during a 1-week period. The images were evaluated with the so called zoomed axial slice movie technique and in some regions intra- and extraluminal surface shaded and volume rendered images were generated on a separate workstation. The results were compared to those of a colonoscopy. RESULTS: The final diagnosis was Crohn's disease in four patients and colitis ulcerosa in one. Total examination was possible by colonoscopy in two cases, and with CT colonography in all five cases. The wall of those segments severely affected by the disease were depicted by the axial CT scans to be thickened. The thick walled, segments with narrow lumen seen on CT colonography corresponded to the regions where colonoscopy was failed to pass. Air filled sinus tracts, thickening of the wall of the terminal ileum, loss of haustration pseudopolyps and deep ulcers were seen in CT colonography. Three dimensional (3D) endoluminal views demonstrated pseudopolyps similar to endoscopic images None of the colonoscopically reported shallow ulcerations or aphtoid ulcerations or granular mucosal surface were observed on 2- or 3D CT colonographic images. CONCLUSION: CT colonography by depicting colonic wall thickening seems to be a useful tool in the diagnosis of Crohn's colitis, which could be a single examination depicting the intraluminal, and transmural extent of the disease.

Enteropathic arthritis in the sacroiliac joint. Imaging and differential diagnosis.

OBJECTIVES: A new high resolution computed tomography (HRCT) scoring system of sacroiliac joint (SIJ) involvement in enteropathic arthritis is introduced. PATIENTS AND METHODS: SIJ's of 100 patients were studied. A total of 25 patients presented with pain syndrome, 25 with suspicious seronegative spondylarthritis, 25 with inflammatory bowel diseases and 25 without joint or bowel diseases, as a control group. HRCT was carried out in all 100 patients. For comparison, a plain film radiography (PFR), conventional CT (slices of 10 mm) and bone scan were used. RESULTS: Quantitative differences: In the pain syndrome group, there were no erosions identified neither intraarticular calcifications. Disc degeneration was seen in 12/25 cases. In 4/25 patients, vacuum phenomena appeared in the SIJ. In 3/25 patients, ventral capsular calcification occurred in the ventral sacroiliac ligament (anterior capsule complex). In the seronegative spondylarthritis group, 16/25 patients had positive findings, while PFR documented erosions only in 3/25 cases. In the bowel diseases group, erosions were detected in 17/25 cases with HRCT, while the plain film was positive only in three cases and in seven cases the findings were questionable. Intraarticular calcification with erosion was documented in three cases and in seven cases without erosion. The bone scan was positive in 7/25 of this cases, but in 5/7 there was mismatching with HRCT. Important new finding was the HRCT detected erosion which was not detected on BS but was obvious on Anti-Granulocyte-Antibody scintigraphy. In the control group, only degenerative changes were seen in 4/25 cases and no erosions. CONCLUSION: HRCT is: (1) the reliable imaging of definitive (often 'cold stage') sacroileitis; (2) gives optimal detection of erosion; and (3) appears to be the only method in the documentation of calcifications in the posterior ligamental portion of the SIJ.