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Impact of Sarcopenia on Clinical Outcomes in a Cohort of Caucasian Active Crohn's Disease Patients Undergoing Multidetector CT-Enterography. Nutrients 2022; 14:nu14173460. [PMID: 36079718 PMCID: PMC9458031 DOI: 10.3390/nu14173460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/21/2022] [Accepted: 08/21/2022] [Indexed: 11/28/2022] Open
Abstract
(1) Background: Sarcopenia has a high incidence in Crohn’s disease (CD) with considerable heterogeneity among ethnicities and variable impact on clinical outcomes. Aim: to assess the impact of sarcopenia on clinical outcomes in a cohort of Caucasian patients with active CD undergoing CT-enterography (CTE) for clinical assessment. We further investigated the prevalence of sarcopenia and its predictors. (2) Methods: Caucasian CD patients with moderate−severe clinical activity, who underwent CTE in an emergency setting, were retrospectively recruited. The skeletal muscle index (SMI) at the third lumbar vertebra was used to detect sarcopenia in the early stages. Clinical malnutrition was defined according to global clinical nutrition criteria. Clinical outcomes included the rate of surgery and infections within one year. (3) Results: A total of 63 CD patients (34 M; aged 44 ± 17 years) were recruited, and 48 patients (68.3%) were sarcopenic. Malnutrition occurred in 28 patients (44.4%) with a significant correlation between body mass index (BMI) and sarcopenia (r = 0.5, p < 0.001). The overall rate of surgery was 33%, without a significant difference between sarcopenic and non-sarcopenic (p = 0.41). The rate of infection in patients with sarcopenia was significantly higher than in non-sarcopenic (42%vs15%, p = 0.03). BMI (OR 0.73,95%, CI 0.57−0.93) and extraintestinal manifestations (EIM) (OR 19.2 95%, CI 1.05−349.1) were predictive of sarcopenia (p < 0.05). (4) Conclusions: Sarcopenia was associated with an increased rate of infections, and it was observed in 68.3% of the Caucasian cohort with active CD.
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Rispo A, de Sire R, Mainenti PP, Imperatore N, Testa A, Maurea S, Ricciolino S, Nardone OM, Olmo O, Castiglione F. David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2022; 29:563-569. [PMID: 35666249 DOI: 10.1093/ibd/izac116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Diagnosis of Crohn's disease (CD) requires ileo-colonoscopy (IC) and cross-sectional evaluation. Recently, "echoscopy" has been used effectively in several settings, although data about its use for CD diagnosis are still limited. Our aim was to evaluate the diagnostic accuracy of handheld bowel sonography (HHBS) in comparison with magnetic resonance enterography (MRE) for CD diagnosis. METHODS From September 2019 to June 2021, we prospectively recruited consecutive subjects attending our third level IBD Unit for suspected CD. Patients underwent IC, HHBS, and MRE in random order with operators blinded about the result of the other procedures. Bivariate correlation between MRE and HHBS was calculated by Spearman coefficient (r). To test the consistency between MRE and HHBS for CD location and complications, the Cohen's k measure was applied. RESULTS Crohn's disease diagnosis was made in 48 out of 85 subjects (56%). Sensitivity, specificity, positive predictive values, and negative predictive values for CD diagnosis were 87.50%, 91.89%, 93.33%, and 85% for HHBS; and 91.67%, 94.59%, 95.65%, and 89.74% for MRE, without significant differences in terms of diagnostic accuracy (89.41% for HHBS vs 92.94% for MRE, P = NS). Magnetic resonance enterography was superior to HHBS in defining CD extension (r = 0.67; P < .01) with a better diagnostic performance than HHBS for detecting location (k = 0.81; P < .01), strictures (k = 0.75; P < .01), abscesses (k = 0.68; P < .01), and fistulas (k = 0.65; P < .01). CONCLUSION Handheld bowel sonography and MRE are 2 accurate and noninvasive procedures for diagnosis of CD, although MRE is more sensitive in defining extension, location, and complications. Handheld bowel sonography could be used as effective ambulatory (or out-of-office) screening tool for identifying patients to refer for MRE examination due to high probability of CD diagnosis.
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Affiliation(s)
- Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Simone Maurea
- Radiology, Department of Advanced Biochemical Sciences, University Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology, Hospital of Ariano Irpino Sant'Ottone-Frangipane, Avellino, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Oriana Olmo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Jiang F, Fu X, Kuang K, Fan D. Artificial Intelligence Algorithm-Based Differential Diagnosis of Crohn's Disease and Ulcerative Colitis by CT Image. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3871994. [PMID: 35419083 PMCID: PMC9001074 DOI: 10.1155/2022/3871994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/18/2022] [Accepted: 02/24/2022] [Indexed: 01/21/2023]
Abstract
The aim of this study was to investigate the effect of low-dose CT enterography (CTE) based on modified guided image filtering (GIF) algorithm in the differential diagnosis of ulcerative colitis (UC) and Crohn's disease (CD). Methods. One hundred and twenty patients with suspected diagnosis of IBD were studied. They were randomly divided into control group (routine CT examination) and observation group (low-dose CTE examination based on improved GIF algorithm), with 60 cases in each group. Comprehensive diagnosis was used as the standard to assess the diagnostic effect. Results. (1) The peak signal-to-noise ratio (PSNR) (26.02 dB) and structural similarity (SSIM) (0.8921) of the algorithm were higher than those of GIF (17.22 dB/0.8491), weighted guided image filtering (WGIF) (23.78 dB/0.8489), and gradient domain guided image filtering (GGIF) (23.77 dB/0.7567) (P < 0.05); (2) the diagnostic sensitivity (91.49%), specificity (92.31%), accuracy (91.67%), positive predictive value (97.73%), and negative predictive value (75%) of the observation group were higher than those of the control group (P < 0.05); the sensitivity and specificity of CTE in the diagnosis of UD and CD were 96.77% and 81.25% and 98.33% and 93.33%, respectively (P < 0.05); there were significant differences in symmetrical intestinal wall thickening and smooth serosal surface between UD and CD (P < 0.05). Conclusion. (1) The improved GIF algorithm has a more effective application value in the denoising processing of low-dose CT images and can better improve the image quality; (2) the accuracy of CTE in the diagnosis of IBD is high, and CTE is of great value in the differential diagnosis of UD and CD.
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Affiliation(s)
- Fangyun Jiang
- Department of Gastroenterology, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Xiaoping Fu
- Department of Neurosurgery, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Kai Kuang
- Department of Gastroenterology, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Dan Fan
- Department of Gastroenterology, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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Camera L, Dell'Aversano-Orabona G, Gambardella M, Riccitiello F, Galatola R, Liuzzi R, Longobardi M, Danzi R, Ponsiglione A, Stanzione A, Maurea S, Brunetti A. Tailored versus fixed scan delay in contrast-enhanced abdominal multi-detector CT: An intra-patient comparison of image quality. Eur J Radiol 2021; 143:109914. [PMID: 34509881 DOI: 10.1016/j.ejrad.2021.109914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To perform anintra-patient comparison betweena single-pass protocol (SP) and a portal venous phase (PVP) by means ofboth quantitative and qualitative analysis of image quality. METHODS Forty patients (31 M; 9F; aged 20-77 years; BMI 23 ± 4 Kg/m2) underwent both a SP and a PVP using a 64-rows multi-detector CT with a median interval time of 56 days (range5-903). All patients underwent i.v. bolus injection (2.0 cc/sec) of 1.7 cc/Kg of a non ionic iodinated contrast-media (370 mgI/ml) with scan delays of 67 ± 8 and 90 s for the SP and the PVP, respectively. Signal- (SNR) and contrast-to-noise ratios (CNR) were calculated for most visceral organs and for both abdominal aorta (AA) and main portal vein (MPV). For qualitative analysis, reproduction of abdominal viscera and vascular structures was blindly evaluated and inter-observer agreement calculated by the weighted Cohen k-analysis. RESULTS Attenuation values (H.U.) of AA (232 ± 53vs180 ± 36) and MPV (215 ± 39vs187 ± 42) were significantly (p < 0.001) higher in the SP than in PVP, respectively. At qualitative analysis, reproduction of mostabdominal viscerawas also significantly sharper (p < 0.001) with the SP than the PVPwith inter-observer agreement scores (k)ranging from 0.60 to 0.88 for all but one imaging criteria. CONCLUSIONS As the SP resulted in a significantly higher vascular enhancement and in a sharper reproduction of most abdominal viscera, it may be better suited than a PVP for the CT evaluation of non traumatic acute abdomen.
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Affiliation(s)
- Luigi Camera
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1).
| | | | - Michele Gambardella
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | | | - Roberta Galatola
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Raffaele Liuzzi
- Institute of Biostructures and Bioimaging (National Research Council), (https://www.cnr.it/en/institute/017), University "Federico II", Naples, Italy(2)
| | - Margaret Longobardi
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Roberta Danzi
- Ospedale S. Maria delle Grazie, Pozzuoli, NA, Italy(3)
| | - Andrea Ponsiglione
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Arnaldo Stanzione
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Simone Maurea
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1)
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Lightner AL, Ashburn JH, Brar MS, Carvello M, Chandrasinghe P, van Overstraeten ADB, Fleshner PR, Gallo G, Kotze PG, Holubar SD, Reza LM, Spinelli A, Strong SA, Tozer PJ, Truong A, Warusavitarne J, Yamamoto T, Zaghiyan K. Fistulizing Crohn's disease. Curr Probl Surg 2020; 57:100808. [PMID: 33187597 DOI: 10.1016/j.cpsurg.2020.100808] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
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Zheng MQ, Zeng QS, Yu YQ, Ji R, Li YY, Zhang MM, Sun YN, Li LX, Zuo XL, Yang XY, Li YQ. Evaluation of the performance of two neutral oral contrast agents in computed tomography enterography: A randomized controlled trial. J Dig Dis 2020; 21:112-119. [PMID: 31825554 PMCID: PMC7065060 DOI: 10.1111/1751-2980.12835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare the performances, tolerability and acceptability of mannitol and polyethylene glycol (PEG) as oral contrast agents in patients undergoing computed tomography enterography (CTE). METHODS Patients aged 18-75 years indicated for CTE were randomized to receive either mannitol or PEG as contrast agents. The coronal reconstructed images of each abdominal quadrant were assessed for maximum distention, proportion of distended bowel loops, presence of inhomogeneous contents and visibility of the small bowel wall. Overall subjective imaging quality assessment and patients' tolerability and acceptability were recorded. RESULTS Seventy patients were enrolled and randomized into two groups. In the per-protocol analysis, no significant differences in imaging quality was found in bowel distention maximum diameter, wall visibility and intestinal homogeneity (all P > 0.05). The mean nausea score was lower in the mannitol group (0 [0-0] vs 1.0 [0-3.0], P < 0.001). Mannitol was superior to PEG in taste (9.0 [8.0-10.0] vs 7.0 [5.0-8.0], P < 0.001), patients' willingness to reuse the drug (9.0 [8.0-10.0] vs 8.0 [7.0-9.0], P = 0.036), satisfaction (9.0 [8.0-10.0] vs 8.0 [7.0-9.0], P = 0.022) and ease of completion (9.0 [8.0-9.3] vs 8.0 [6.5-9.0], P = 0.030). CONCLUSIONS Both mannitol and PEG provided good bowel distention and visualization of the bowel wall. However, mannitol was significantly superior to PEG in patients' tolerability and acceptability.
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Affiliation(s)
- Meng Qi Zheng
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Qing Shi Zeng
- Department of RadiologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Yong Quan Yu
- Department of RadiologyWeihai Central HospitalWeihaiShandong ProvinceChina
| | - Rui Ji
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Yue Yue Li
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Ming Ming Zhang
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Yi Ning Sun
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Li Xiang Li
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Xiu Li Zuo
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Xiao Yun Yang
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
| | - Yan Qing Li
- Department of GastroenterologyQilu Hospital of Shandong UniversityJinanShandong ProvinceChina,Department of Laboratory of Translational GastroenterologyQilu Hospital of Shandong UniverisityJinanShandong ProvinceChina,Department of Robot Engineering Laboratory for Precise Diagnosis and Therapy of GI TumorQilu Hospital of Shandong UniversityJinanShandong ProvinceChina
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