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Bihain F, Caron B, Ayav A, Peyrin-Biroulet L, Laurent V, Germain A. Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn's Disease. Dis Colon Rectum 2023; 66:e1119-e1127. [PMID: 36102838 DOI: 10.1097/dcr.0000000000002477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The European Crohn's and Colitis Organization guidelines have highlighted the importance of the preoperative evaluation of the affected segment length in patients with ileocolic Crohn's disease to determine the best surgical approach. OBJECTIVE This study aimed to evaluate the accuracy of preoperative magnetic resonance enterography in assessing the length of the affected segment in patients with ileocolic Crohn's disease. DESIGN This observational study was conducted with a prospectively maintained database and retrospective analysis. SETTINGS This study was conducted in a tertiary center. PATIENTS This study included consecutive patients undergoing ileocolic resection for Crohn's disease between August 2014 and June 2020. All patients underwent a preoperative magnetic resonance enterography. MAIN OUTCOME MEASURES The correlation between the length measured on magnetic resonance enterography and pathological examination was evaluated. RESULTS A total of 96 patients were included. The median time between magnetic resonance enterography and surgery was 65.5 (3-331) days. The length of the affected segment on magnetic resonance enterography was correlated with the length assessed on pathological evaluation ( R = 0.48, p < 0.001). No correlation was found between the 2 measurements when imaging was performed >6 months before surgery ( R = 0.14, p = 0.62). The presence of an abscess underestimated the length affected by Crohn's disease on imaging compared to pathology, whereas the presence of a fistula was associated with magnetic resonance enterography overestimation of the length of the affected segment. LIMITATIONS Limitations included single-center study and retrospective analysis. CONCLUSION In Crohn's disease, preoperative magnetic resonance enterography is a highly reliable tool for predicting the length of the affected segment compared to pathology examination in the absence of an abscess or fistula. See Video Abstract at http://links.lww.com/DCR/C26 . ENTEROGRAFA POR RESONANCIA MAGNTICA PREOPERATORIA PARA PREDECIR LA LONGITUD DE MUESTRAS PATOLGICAS EN LA ENFERMEDAD DE CROHN ANTECEDENTES:Las guías de la Organización Europea de Crohn y Colitis han resaltado la importancia de la evaluación preoperatoria de la longitud del segmento afectado para determinar el mejor abordaje quirúrgico.OBJETIVO:Evaluamos la precisión de la enterografía por resonancia magnética preoperatoria para evaluar la longitud del segmento afectado en pacientes con enfermedad de Crohn ileocólica.DISEÑO:Realizamos un estudio observacional con una base de datos mantenida prospectivamente y un análisis retrospectivo.CONFIGURACIÓN:Este estudio se realizó en un centro terciario.PACIENTES:Se incluyeron pacientes consecutivos sometidos a resección ileocólica por enfermedad de Crohn entre Agosto de 2014 y Junio de 2020. A todos los pacientes se les realizó una enterografía por resonancia magnética preoperatoria.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluó la correlación entre la longitud medida en la enterografía por resonancia magnética y el examen patológico.RESULTADOS:Se incluyeron un total de 96 pacientes. El tiempo mediano entre la enterografía por resonancia magnética y la cirugía fue de 65,5 (3-331) días. La longitud del segmento afectado en la enterografía por resonancia magnética se correlacionó con la longitud evaluada en la evaluación patológica ( R = 0,48, p < 0,001). No hubo correlación entre las 2 mediciones cuando las imágenes se realizaron más de 6 meses antes de la cirugía ( R = 0,14, p = 0,62). La presencia de un absceso subestimó la longitud afectada por la enfermedad de Crohn en las imágenes en comparación con la patología, mientras que la presencia de una fístula se asoció con una sobrestimación de la longitud del segmento afectado por enterografía por resonancia magnética.LIMITACIONES:Las limitaciones incluyeron un estudio de un solo centro y un análisis retrospectivo.CONCLUSIÓNES:En la enfermedad de Crohn, la enterografía por resonancia magnética preoperatoria es una herramienta altamente confiable para predecir la longitud del segmento afectado en comparación con el examen de patología, en ausencia de absceso o fístula. Consulte el Video Resumen en http://links.lww.com/DCR/C26 . (Traducción-Dr. Yesenia Rojas-Khalil ).
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Affiliation(s)
- Florence Bihain
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ahmet Ayav
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Department of Radiology, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Adeline Germain
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
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Alahdab YO, Demirtas CO, Kani HT, Tuney D, Seker L, Tolu T, Atug O. Clinical significance of isolated abnormal intestinal findings in magnetic resonance enterography in patients with suspected small bowel disease. Abdom Radiol (NY) 2020; 45:1036-1043. [PMID: 31686178 DOI: 10.1007/s00261-019-02297-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRE) is a well-established adjunct diagnostic tool for the diagnosis of Crohn's Disease (CD), as ileocolonoscopy can sometimes be falsely reassuring when CD skips distal terminal ileum. We aimed to determine the frequency and clinical significance of isolated abnormal small bowel findings in MRE with normal ileal view in ileoscopy. METHODS We retrospectively reviewed findings from 1611 MRE studies that were conducted between 2012 and 2018 to detect patients bearing abnormal intestinal findings and having full ileocolonoscopy. After exclusion of normal or repetitive MRE scans and previously known CD, 147 patients with abnormal MRE detected. MRE scans were categorized as suspicious of CD and non-specific findings. RESULTS Out of 147 patients with abnormal MRE, 122 (83%) had terminal ileum involvement in MRE consistent with ileoscopy findings. Twenty-five (17%) patients were found to have solitarily abnormal intestinal findings in MRE with normal ileoscopy. Only 3 (12%) were diagnosed with CD initially, and all had MRE findings suspicious of CD. The remainder 40% (n = 10) were diagnosed with non-Crohn's small bowel disease after further investigation, while in the other 48% (n = 12) abnormal MRE findings could not be explained with any organic disease in the follow-up. CONCLUSION The present study demonstrated that only a small portion of patients with isolated abnormal intestinal findings in MRE is CD, and more than that are non-crohn's small bowel diseases. These findings, even if they carry the suspicion of CD, do not transform to CD in the long-term follow-up.
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Affiliation(s)
- Yesim Ozen Alahdab
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Coskun Ozer Demirtas
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey.
| | - Haluk Tarik Kani
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Davut Tuney
- Department of Radiology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Lamia Seker
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Tugba Tolu
- Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ozlen Atug
- Department of Gastroenterology, Marmara University, School of Medicine, Istanbul, Turkey
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Gandhi NS, Dillman JR, Grand DJ, Huang C, Fletcher JG, Al-Hawary MM, Anupindi SA, Baker ME, Bruining DH, Chatterji M, Fidler JL, Gee MS, Grajo JR, Guglielmo FF, Jaffe TA, Park SH, Rimola J, Taouli B, Taylor SA, Yeh B. Computed tomography and magnetic resonance enterography protocols and techniques: survey of the Society of Abdominal Radiology Crohn's Disease Disease-Focused Panel. Abdom Radiol (NY) 2020; 45:1011-1017. [PMID: 31982931 DOI: 10.1007/s00261-020-02407-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE To survey Society of Abdominal Radiology Crohn's Disease (CD) Disease-Focused Panel (DFP) members to understand state-of-the-art CT/MR enterography (CTE/MRE) protocols and variability between institutions. METHODS This study was determined by an institutional review board to be "exempt" research. The survey consisted of 70 questions about CTE/MRE patient preparation, administration of contrast materials, imaging techniques, and other protocol details. The survey was administered to DFP members using SurveyMonkey® (Surveymonkey.com). Descriptive statistical analyses were performed. RESULTS Responses were received from 16 DFP institutions (3 non-USA, 2 pediatric); 15 (94%) were academic/university-based. 10 (63%) Institutions image most CD patients with MRE; 4 (25%) use CTE and MRE equally. Hypoperistaltic medication is given for MRE at 13 (81%) institutions versus only 2 (13%) institutions for CTE. Most institutions have a technologist or nurse monitor oral contrast material drinking (n = 12 for CTE, 75%; n = 11 for MRE, 69%). 2 (13%) institutions use only dual-energy capable scanners for CTE, while 9 (56%) use either a single-energy or dual-energy scanner based on availability. Axial CTE images are reconstructed at 2-3 mm thickness at 8 (50%) institutions, > 3 mm at 5 (31%), and < 2 mm at 3 (19%) institutions. 13 (81%) institutions perform MRE on either 1.5 or 3T scanners without preference. All institutions perform MRE multiphase postcontrast imaging (median = 4 phases), ranging from 20 to 600 s after contrast material injection. CONCLUSION CTE and MRE protocol knowledge from DFP institutions can help radiology practices optimize/standardize protocols, potentially improving image quality and patient outcomes, permitting objective comparisons between examinations, and facilitating research.
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Affiliation(s)
- Namita S Gandhi
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David J Grand
- Department of Radiology, Rhode Island Hospital, Providence, RI, USA
| | - Chenchan Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Mahmoud M Al-Hawary
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia & University of Pennsylvania, Philadelphia, PA, USA
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave/L10, Cleveland, OH, 44195, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Manjil Chatterji
- Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph R Grajo
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Tracy A Jaffe
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Benjamin Yeh
- Department of Radiology, University of California, San Francisco, USA
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Kim MJ. [Preparation, Technique, and Imaging of Computed Tomography/Magnetic Resonance Enterography]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2020; 75:86-93. [PMID: 32098462 DOI: 10.4166/kjg.2020.75.2.86] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
CT enterography and magnetic resonance (MR) enterography are widely used imaging modalities used to examine the small bowel. These radiologic tests are distinguished from routine abdominopelvic CT and MRI by the oral ingestion of a large amount of neutral contrast to distend the small bowel before scanning. For achievement of high quality, diagnostic images and proper technique are required. Conducted protocols still vary in patient preparation, enteric contrast, and CT and MRI acquisition sequences, resulting in heterogeneous diagnostic accuracy. The purpose of this article is to review the processes and techniques that optimize CT/MR enterography for patients with suspected Crohn's disease or other small bowel diseases.
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Affiliation(s)
- Min Ju Kim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Bhatnagar G, Von Stempel C, Halligan S, Taylor SA. Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease. J Magn Reson Imaging 2016; 45:1573-1588. [PMID: 27943484 DOI: 10.1002/jmri.25569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Cross sectional Imaging plays an increasingly important role the diagnosis and management of Crohn's disease. Particular emphasis is placed on MRI and Ultrasound as they do not impart ionising radiation. Both modalities have reported high sensitivity for disease detection, activity assessment and evaluation of extra-luminal complications, and have positive effects on clinical decision making. International Guidelines now recommend MRI and Ultrasound in the routine management of Crohn's disease patients. This article reviews the current evidence base supporting both modalities with an emphasis on the key clinical questions. We describe current protocols, basic imaging findings and highlight areas in need of further research. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1573-1588.
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Affiliation(s)
- Gauraang Bhatnagar
- Frimley Park Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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6
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Evolving roles of cross-sectional imaging in Crohn's disease. Dig Liver Dis 2016; 48:975-83. [PMID: 27338853 DOI: 10.1016/j.dld.2016.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/13/2016] [Accepted: 05/21/2016] [Indexed: 12/11/2022]
Abstract
The implementation of cross-sectional imaging techniques for the clinical management of Crohn's disease patients has steadily grown over the recent years, thanks to a series of technological advances, including the evolution of contrast media for magnetic resonance, computed tomography and bowel ultrasound. This has resulted in a continuous improvement of diagnostic accuracy and capability to detect Crohn's disease-related complications. Additionally, a progressive widening of indications for cross-sectional imaging in Crohn's disease has been put forward, thus leading to hypothesize that in the near future imaging techniques can increasingly complement endoscopy in most clinical settings, including the grading of disease activity and the assessment of mucosal healing or Crohn's disease post-surgical recurrence.
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7
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Sharma R, Madhusudhan KS, Ahuja V. Intestinal tuberculosis versus crohn's disease: Clinical and radiological recommendations. Indian J Radiol Imaging 2016; 26:161-72. [PMID: 27413261 PMCID: PMC4931773 DOI: 10.4103/0971-3026.184417] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intestinal tuberculosis is a common clinical problem in India. The clinical features of this disease are nonspecific and can be very similar to Crohn's disease. Radiological evaluation of the small bowel has undergone a paradigm shift in the last decade. This long tubular organ that has traditionally been difficult to evaluate can now be well-visualized by some innovative imaging and endoscopic techniques. This article highlights the state-of-the-art evaluation of ulceroconstrictive diseases of the bowel and provides recommendations for the differentiation of intestinal tuberculosis from Crohn's disease.
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Affiliation(s)
- Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Kumble S Madhusudhan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Vineet Ahuja
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE Patients with inflammatory bowel disease (IBD) may be exposed to high doses of diagnostic radiation. The purpose of this study is to identify subsets of this population at risk for significant radiation exposure. METHODS This HIPAA compliant, IRB approved study consists of 336 patients (237 adult and 99 pediatric) within the Ocean State Crohn's & Colitis Area Registry (OSCCAR). All were newly diagnosed with IBD and prospectively enrolled between 1/2008 and 12/2012. Comprehensive chart review was performed. RESULTS 207 (61.6%) patients were diagnosed with Crohn's disease (CD), 120 (35.7%) with ulcerative colitis (UC), and 9 (2.7%) with inflammatory bowel disease, type unspecified (IBDU). 192 (57.1%) patients were exposed to GI-specific radiation. Average GI-specific radiation dose for adult IBD patients was 14.1 mSV and was significantly greater among adult CD than adult UC patients (p = 0.01). Pediatric patients underwent fewer CT scans (p < 0.0001). Risk factors for increased radiation exposure include: GI surgery (p = 0.003), biologic therapy (p = 0.01), pain-predominant symptoms (as compared to diarrhea-predominant symptoms; p < 0.05), and isolated ileal disease (p = 0.02). Patients with stricturing or penetrating disease received higher radiation doses than patients with non-stricturing, non-penetrating disease (p < 0.0001). CONCLUSIONS A variety of risk factors are associated with increased exposure to ionizing radiation after diagnosis of IBD. Knowledge of these risk factors can help physicians prospectively identify patients at risk for elevated radiation exposure and consider low-dose or radiation-free imaging.
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Aryan A, Azizi Z, Teimouri A, Ebrahimi Daryani N, Aletaha N, Jahanbakhsh A, Nouritaromlou MK, Alborzi F, Mami M, Basirat V, Javid Anbardan S. The Diagnostic Role of Magnetic Resonance Enterography as a Complementary Test to Colonoscopy in Active Crohn's Disease. Middle East J Dig Dis 2016; 8:93-101. [PMID: 27252815 PMCID: PMC4885618 DOI: 10.15171/mejdd.2016.13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND
According to recent studies comparing magnetic resonance enterography
(MRE) with ileocolonoscopy for assessing inflammation of small bowel and
colonic segments in adults with active Crohn’s disease (CD), we aimed to compare
the accuracy of these two diagnostic methods in Iranian population.
METHODS
During 2013-2014 a follow-up study was done on 30 patients with active CD
in a gastroenterology clinic affiliated to Tehran University of Medical Sciences.
MRE and ileocolonoscopy were performed for all the patients. All statistical
analyses were performed using SPSS (version 18) and p-value<0.05 was considered
as statistically significant.
RESULTS
Of the 30 patients with active CD, 11(36.7%) were men and 19 (63.3%) were
women with mean age of 37.30±13.66 years (range: 19-67 years). MRE had sensitivity
and specificity of 50% and 90% with positive predictive value (PPV) and
negative predictive value (NPV) of 71.43 and 78.26, respectively for localizing
sigmoid lesions and ileum had sensitivity and specificity of 84.21 and 45.45 with
PPV and NPV of 72.73 and 62.50, respectively.
CONCLUSION
While moderate sensitivity and high specificity of MRE in localizing colonic
lesions makes it an appropriate confirmatory test after colonoscopy, the
reported high sensitivity and moderate specificity of MRE versus colonoscopy
in detecting ileal lesions makes it a suitable screening test for ileal lesions.
Finally we can conclude that MRE can be an important complementary test to
colonoscopy in detecting active disease.
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Affiliation(s)
- Arvin Aryan
- Assistant Professor of Radiology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Zahra Azizi
- Researcher, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Teimouri
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Nasser Ebrahimi Daryani
- Professor of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Najme Aletaha
- Assistant Professor of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Ali Jahanbakhsh
- Researcher, Tehran University of Medical Science, Tehran, Iran
| | | | - Forough Alborzi
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Masoud Mami
- Fellow of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Vahid Basirat
- Resident of Internal Medicine, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
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Detection of small bowel tumor based on multi-scale curvelet analysis and fractal technology in capsule endoscopy. Comput Biol Med 2016; 70:131-138. [PMID: 26829705 DOI: 10.1016/j.compbiomed.2016.01.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 01/14/2016] [Accepted: 01/16/2016] [Indexed: 02/07/2023]
Abstract
Wireless capsule endoscopy (WCE) has been a revolutionary technique to noninvasively inspect gastrointestinal (GI) tract diseases, especially small bowel tumor. However, it is a tedious task for physicians to examine captured images. To develop a computer-aid diagnosis tool for relieving the huge burden of physicians, the intestinal video data from 89 clinical patients with the indications of potential tumors was analyzed. Out of the 89 patients, 15(16.8%) were diagnosed with small bowel tumor. A novel set of textural features that integrate multi-scale curvelet and fractal technology were proposed to distinguish normal images from tumor images. The second order textural descriptors as well as higher order moments between different color channels were computed from images synthesized by the inverse curvelet transform of the selected scales. Then, a classification approach based on support vector machine (SVM) and genetic algorithm (GA) was further employed to select the optimal feature set and classify the real small bowel images. Extensive comparison experiments validate that the proposed automatic diagnosis scheme achieves a promising tumor classification performance of 97.8% sensitivity and 96.7% specificity in the selected images from our clinical data.
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Puylaert CAJ, Tielbeek JAW, Bipat S, Stoker J. Grading of Crohn's disease activity using CT, MRI, US and scintigraphy: a meta-analysis. Eur Radiol 2015; 25:3295-313. [PMID: 26080794 PMCID: PMC4595539 DOI: 10.1007/s00330-015-3737-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 02/11/2015] [Accepted: 03/25/2015] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess the grading of Crohn's disease activity using CT, MRI, US and scintigraphy. MATERIALS AND METHODS MEDLINE, EMBASE and Cochrane databases were searched (January 1983-March 2014) for studies evaluating CT, MRI, US and scintigraphy in grading Crohn's disease activity compared to endoscopy, biopsies or intraoperative findings. Two independent reviewers assessed the data. Three-by-three tables (none, mild, frank disease) were constructed for all studies, and estimates of accurate, over- and under-grading were calculated/summarized by fixed or random effects models. RESULTS Our search yielded 9356 articles, 19 of which were included. Per-patient data showed accurate grading values for CT, MRI, US and scintigraphy of 86% (95% CI: 75-93%), 84% (95% CI: 67-93%), 44% (95% CI: 28-61%) and 40% (95% CI: 16-70%), respectively. In the per-patient analysis, CT and MRI showed similar accurate grading estimates (P = 0.8). Per-segment data showed accurate grading values for CT and scintigraphy of 87% (95% CI: 77-93%) and 86% (95% CI: 80-91%), respectively. MRI and US showed grading accuracies of 67-82% and 56-75%, respectively. CONCLUSIONS CT and MRI showed comparable high accurate grading estimates in the per-patient analysis. Results for US and scintigraphy were inconsistent, and limited data were available. KEY POINTS • CT and MRI have comparable high accuracy in grading Crohn's disease. • Data on US and scintigraphy is inconsistent and limited. • MRI is preferable over CT as it lacks ionizing radiation exposure.
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Affiliation(s)
- C A J Puylaert
- Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands.
| | - J A W Tielbeek
- Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
| | - S Bipat
- Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
| | - J Stoker
- Academic Medical Center, Department of Radiology, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands
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Predicting the Need for Imaging in IBD: Radiating Only Badness? Dig Dis Sci 2015; 60:813-5. [PMID: 25875756 DOI: 10.1007/s10620-015-3573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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He B, Gong S, Hu C, Fan J, Qian J, Huang S, Cui L, Ji Y. Obscure gastrointestinal bleeding: diagnostic performance of 64-section multiphase CT enterography and CT angiography compared with capsule endoscopy. Br J Radiol 2014; 87:20140229. [PMID: 25248830 DOI: 10.1259/bjr.20140229] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare the diagnostic capabilities between capsule endoscopy (CE) and multislice CT (MSCT) enterography in combination with MSCT angiography for assessment of obscure gastrointestinal bleeding (OGIB). METHODS A total of 127 patients with OGIB were looked at in this study. 82 patients (aged 42.7 ± 19.1 years; 34 males) were assigned to receive MSCT diagnosis and 67 patients to (aged 53.9 ± 16.2 years; 28 males) receive CE diagnosis. Among them, 22 patients (aged 54.1 ± 19.1 years; 12 males) received both examinations. Oral isotonic mannitol and intramuscular injection of anisodamine were performed; non-ionic contrast (iopromide, 370 mg I ml(-1)) was intravenously administered; and then multiphase scanning was conducted at arterial, small intestinal and portal venous phases in MSCT. The results were compared with findings of reference standards including double balloon enteroscopy, digital subtraction angiography, intraoperative pathological examination and/or clinical diagnosis. RESULTS Administration of anisodamine markedly increased the satisfaction rate of bowel filling (94.67% vs 28.57%; p < 0.001) but not the diagnostic yield (p = 0.293) of MSCT. Compared with MSCT, CE showed an improved overall diagnostic yield (68.66% vs 47.56%; p = 0.010), which was also observed in overt bleeding patients (i.e. patients with continued passage of visible blood) (76.19% vs 51.02%; p = 0.013) and in patients aged younger than 40 years of age (85% vs 51.28%; p = 0.024). However, CE had similar positive rates to MSCT (p > 0.05). Among the 22 cases in whom both examinations were conducted, CE showed no significantly different diagnostic capability compared with MSCT (p = 0.4597). CONCLUSION Both CE and MSCT are safe and effective diagnostic methods for OGIB. ADVANCES IN KNOWLEDGE CE is preferred for overt bleeding or patients aged younger than 40 years. The combined use of CE and MSCT is recommended in OGIB diagnosis.
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Affiliation(s)
- B He
- 1 Department of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu, China
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Qiu Y, Mao R, Chen BL, Li XH, He Y, Zeng ZR, Li ZP, Chen MH. Systematic review with meta-analysis: magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn's disease. Aliment Pharmacol Ther 2014; 40:134-46. [PMID: 24912799 DOI: 10.1111/apt.12815] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/06/2014] [Accepted: 05/12/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Magnetic resonance enterography (MRE) has been proposed as a non-ionising alternative method to computed tomography enterography (CTE). Some studies have directly compared CTE and MRE in patients with small bowel Crohn's disease (CD) with variable results. AIM To compare the overall diagnostic accuracy in assessing the activity of small bowel and complications. METHODS MEDLINE, EMBASE and Cochrane databases were searched for studies on the accuracy of MRE and CTE, as compared with a pre-defined reference standard. Pooled sensitivity, specificity, the weighted area under the curve (AUC), incremental yield (IY) and other diagnostic indices were evaluated. RESULTS A total of 290 CD patients from six different studies were analysed. The pooled sensitivity and specificity for MRE in detecting active small bowel CD was 87.9% [95% confidence interval (CI), 81.8-92.5] and 81.2% (95% CI: 71.9-88.4) respectively. The AUC under the summary receiver-operating characteristic (sROC) of MRE was 0.905 (SEM 0.03, standard error of the mean). Likewise, the pooled sensitivity and specificity of CTE in detecting active small bowel CD was 85.8% (95% CI: 79.2-90.9) and 83.6% (95% CI: 75.3-90.1) with the AUC of 0.898. The AUC of MRE in detecting fistula, stenosis and abscess was 0.936, 0.931 and 0.996, respectively, compared to 0.963, 0.616 and 0.899 of CTE. No statistically significant IY for MRE vs. CTE was found (fixed model, P > 0.05). CONCLUSIONS Magnetic resonance enterography has a diagnostic effectiveness comparable to computed tomography enterography, thus may serve as a radiation-free alternative for evaluation of patients with Crohn's disease.
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Affiliation(s)
- Y Qiu
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Diagnostic imaging in Crohn's disease: what is the new gold standard? Best Pract Res Clin Gastroenterol 2014; 28:421-36. [PMID: 24913382 DOI: 10.1016/j.bpg.2014.04.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/06/2014] [Accepted: 04/13/2014] [Indexed: 01/31/2023]
Abstract
Historically Barium and isotope studies been used for imaging of inflammatory bowel disease (IBD) but carry risk of radiation exposure. Use of Barium is declining resulting in fewer radiologists that have the necessary expertise. Isotopes studies lack anatomical definition but 18F - fludeoxyglucose (FDG) positron emission tomography (PET) shows promise in accurate assessment of disease compared to endoscopy. Computerised tomography (CT) is particularly useful in assessment of complications of Crohn's disease (CD) but radiation exposure is high. CT enterography (CTE) has improved visualisation of small bowel mucosal disease and allows assessment of disease activity. Ultrasound is increasingly used for preliminary assessment of patients with potential IBD. Although widely available and economically attractive, the expertise required is not widespread. Finally magnetic resonance imaging (MRI) is proving to be the most accurate tool for assessment of disease extent and distribution. MRI of the pelvis has superseded other techniques in assessment of peri-anal fistulation.
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Disease course and surgery rates in inflammatory bowel disease: a population-based, 7-year follow-up study in the era of immunomodulating therapy. Am J Gastroenterol 2014; 109:705-14. [PMID: 24642581 DOI: 10.1038/ajg.2014.45] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/05/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In this population-based 7-year follow-up of incident patients with ulcerative colitis (UC) or Crohn's disease (CD), we aimed to describe disease progression and surgery rates in an era influenced by the increased use of immunosuppressants and the introduction of biological therapy. METHODS From 1 January 2003 to 31 December 2004, all incident cases (562) of patients diagnosed with UC, CD, or inflammatory bowel disease unclassified in a well-defined Copenhagen area were registered. Medical records were reviewed from 1 November 2011 to 30 November 2012, and clinical data were registered. Clinical data on surgery, cancer, and death were cross-checked with register data from national health administrative databases in order to include missed data. RESULTS In total, 513 patients (213 CD and 300 UC) entered the follow-up study. Twenty-six patients changed diagnosis during the follow-up. Changes in disease localization and behavior in CD according to the Vienna classification were observed in 23.9% and 15.0% of the patients, respectively, during follow-up. In total, 28.3% of the 300 UC patients had disease progression during the follow-up. The overall use of systemic steroids, immunomodulators, and anti-tumor necrosis factor agents in CD was 86.4%, 64.3%, and 23.5%, respectively. The rate of first-time intestinal resection in CD was 29.1% (n=62), and the 7-year cumulative risk was 28.5%. The cumulative risk of colectomy in UC was 12.5% at 7 years. CONCLUSIONS UC and CD are dynamic diseases that progress in extent and behavior over time. The resection rate in CD and the colectomy rate in UC are still relatively high, although the rates seem to have decreased compared with historic data, which could be due to an increase in the use of immunomodulating therapy.
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Outcomes of computed tomography and magnetic resonance enterography in clinical practice of inflammatory bowel disease. Dig Dis Sci 2014; 59:838-49. [PMID: 24323180 DOI: 10.1007/s10620-013-2964-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/15/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn's disease. AIM We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center. METHODS We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography. RESULTS A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn's disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum (n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn's in 5/311 (1.6 %) studies. CONCLUSION Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD.
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Naganuma M, Hosoe N, Ogata H. Inflammatory bowel disease and novel endoscopic technologies. Dig Endosc 2014; 26 Suppl 1:20-8. [PMID: 24033394 DOI: 10.1111/den.12161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 07/22/2013] [Indexed: 12/21/2022]
Abstract
Conventional ileocolonoscopy and barium small bowel follow-through are useful techniques for assessing the extension and severity of disease in patients with inflammatory bowel disease (IBD). More recently, novel techniques to enable IBD diagnosis have been developed, such as capsule endoscopy (CE), balloon enteroscopy (BE), computed tomography enterography (CTE) and magnetic resonance enterography (MRE). The advantages of CE and BE are that they enable mucosal assessment directly whereas the usefulness of CTE/MRE is in its ability to enable detection of transmural inflammation, stenosis, and extraintestinal lesions including abscesses and fistulas. In ulcerative colitis (UC), colitis-associated dysplasia/cancer is one of the critical complications in patients with chronic disease. Detection of colitis-associated cancer is difficult in cases with inflammation. Magnification colonoscopy has been used to detect dysplasia in patients with chronic UC. Furthermore, colon CE and endocytoscopy have also developed and these might be used for selected patients in the near future.
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Affiliation(s)
- Makoto Naganuma
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
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Paparo F, Revelli M, Puppo C, Bacigalupo L, Garello I, Garlaschi A, Biscaldi E, Rollandi L, Binda GA, Rollandi GA. Crohn's disease recurrence in patients with ileocolic anastomosis: value of computed tomography enterography with water enema. Eur J Radiol 2013; 82:e434-40. [PMID: 23727378 DOI: 10.1016/j.ejrad.2013.04.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/26/2013] [Accepted: 04/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The main objective of the present work was to determine the diagnostic value of CT-enterography with water enema (CTe-WE) in the assessment of the ileocolic anastomosis in patients with Crohn's disease (CD). The prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomosis was also determined. Further, the association between the type of ileocolic anastomosis and the behavior (i.e. inflammatory, stricturing, penetrating) of CD recurrence was evaluated. METHODS 51 patients were retrospectively included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35). Ileocolic anastomoses were: 18 (35.3%) stapled side-to-side, 17 (33.3%) end-to-side, and 16 (31.4%) end-to-end. CTe-WEs were reviewed in consensus by two gastrointestinal radiologists. Endoscopy and medical records were used as reference standards. RESULTS CTe-WE yielded 95.35% sensitivity (CI 95%: 84.19-99.43%), 75.00% specificity (CI 95%: 34.91-96.81%), and 92.15% diagnostic accuracy (CI 95%: 81.31-98.02%). Anastomotic recurrence was found in 41/51 (80.4%) patients, including 30/41 (73.2%) cases of isolated anastomotic recurrence, and 11/41 (26.8%) cases of anastomotic recurrence with a SIL. A significant lower prevalence of stricturing recurrence was observed in patients with stapled side-to-side anastomoses (p=0.033). CONCLUSIONS CTe-WE provides a good distension of both sides of ileocolic anastomoses allowing the detection of SILs.
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Affiliation(s)
- Francesco Paparo
- Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy
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