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Bartlett DJ, Ramos GP, Fletcher JG, Bruining DH. Imaging Evaluation of Inflammatory Bowel Disease Complications. Gastrointest Endosc Clin N Am 2022; 32:651-673. [PMID: 36202508 DOI: 10.1016/j.giec.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition that can progress to fibrostenotic and penetrating complications. Cross-sectional imaging is often needed for accurate diagnosis of IBD complication and for planning the appropriate management strategy. Computed tomography enterography, magnetic resonance enterography, and IBD ultrasound have become key tools for clinicians and interventional endoscopists. This article highlights and discusses various radiologic imaging techniques and their application to the diagnosis and management of IBD complications.
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Affiliation(s)
- David J Bartlett
- Department of Radiology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA; Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Guilherme Piovezani Ramos
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 1st Street, SW, Rochester, MN 55905, USA.
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Dane B, Qian K, Krieger R, Smereka P, Foster J, Huang C, Chang S, Kim S. Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:3424-3435. [PMID: 35916941 DOI: 10.1007/s00261-022-03624-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To retrospectively evaluate which key imaging features described by SAR-AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD. METHODS 52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index. RESULTS 19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568-0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar. CONCLUSION Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.
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Affiliation(s)
- Bari Dane
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA.
| | - Kun Qian
- NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY, 10016, USA
| | - Rachel Krieger
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Paul Smereka
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Jonathan Foster
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Chenchan Huang
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Shannon Chang
- NYU Langone Health Department of Gastroenterology, 305 E 33rd Street, New York, NY, 10016, USA
| | - Sooah Kim
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
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3
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Al-Ani AH, Vaughan R, Christensen B, Bryant RV, Novak KL. Treat to transmural healing: how to incorporate intestinal ultrasound into the treatment of inflammatory bowel disease. Br J Radiol 2022; 95:20211174. [PMID: 35766939 PMCID: PMC10996947 DOI: 10.1259/bjr.20211174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intestinal ultrasound (IUS) is emerging as a key tool to achieving the therapeutic target of transmural healing in inflammatory bowel disease (IBD). IUS is a non-invasive, radiation-free, imaging modality comparable to MRI, CT and ileocolonoscopy (IC). With the appropriate training and equipment, IUS can be an easily repeatable bedside test for IBD diagnosis and disease monitoring, including treatment response. Core to successful high quality IUS employment are appropriate training and expert techniques; however, the training pathway will not be explored in this review. Given the increasing shift towards objective assessment for tight disease control, gastroenterologist-led IUS should be incorporated into the armamentarium of imaging modalities alongside radiologists, to enhance our diagnostic and monitoring toolbox. This comprehensive review aims to outline the current literature around IUS and propose the placement of IUS in a treat-to-target algorithm in IBD. Ultimately, IUS facilitates timely management decisions to optimise patient care with potential to revolutionise patient outcomes, moving towards transmural healing as the holy grail of therapy in IBD.
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Affiliation(s)
- Aysha H Al-Ani
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Rose Vaughan
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Britt Christensen
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Kerri L Novak
- Department of Gastroenterology, The University of Calgary, Alberta, Australia
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Comparison of Diagnostic Performance of Ultrasonography and Magnetic Resonance Enterography in the Assessment of Active Bowel Lesions in Patients with Crohn’s Disease: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12082008. [PMID: 36010359 PMCID: PMC9407121 DOI: 10.3390/diagnostics12082008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to evaluate and compare the diagnostic performances of ultrasonography (US) and magnetic resonance enterography (MRE) in assessing active bowel lesions in patients with Crohn’s disease (CD). Materials and Methods: We searched PubMed and EMBASE for studies in which US and MRE were used to assess active bowel lesions in CD patients. Bivariate random effect meta-analytic methods were used to estimate pooled sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) curves. We performed a meta-regression analysis to explore the source of study heterogeneity. Results: Eleven studies involving 752 patients were included. US exhibited a pooled sensitivity of 86% (95% confidence interval (CI) 72–94), pooled specificity of 88% (95% CI 78–94), and HSROC of 0.93 in 10 studies. MRE exhibited a pooled sensitivity of 88% (95% CI 76–95), pooled specificity of 87% (95% CI 73–95), and an HSROC of 0.94 in eight studies. In seven studies comparing the diagnostic performances of US and MRE, the summary sensitivity of US and MRE were 86% (95% CI 65–96, I2 = 92.1) and 86% (95% CI 72–93, I2 = 88.1) (p = 0.841), respectively. The summary specificity of US and MRE were 87% (95% CI 78–93, I2 = 79.8%) and 84% (72–90, I2 = 72.5%) (p = 0.431), respectively, which showed no statistical differences. On meta-regression analysis, studies from Europe (p = 0.002), those that used linear US probes (p = 0.012), those on small bowel lesions (p = 0.01), and those with outcomes as combined features (active inflammation) reported higher US sensitivity than those from other regions, those that used both linear and convex US probes, those on small and large bowels, and those with outcome as one feature (bowel wall thickening or ulcer). Studies with pediatric patients (p = 0.001), those with reference standards including US (p = 0.001), and outcomes as combined features (p = 0.01) reported higher MRE specificity than those with adult populations, reference standards other than the US, and outcomes as one feature. Conclusions: In spite of considerable heterogeneity in the included studies, both US and MRE can diagnose active bowel lesions with comparable diagnostic accuracy in patients with CD. The study region, type of US probe, lesion location, investigated outcome for US sensitivity and study population, reference standards, and investigated outcomes for MRE specificity were potential sources of heterogeneity.
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Contrast-enhanced ultrasound in the assessment of Crohn’s disease activity: comparison with computed tomography enterography. Radiol Med 2022; 127:1068-1078. [DOI: 10.1007/s11547-022-01535-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 12/07/2022]
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Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal Pain in the Emergency Department: How to Select the Correct Imaging for Diagnosis. Open Access Emerg Med 2022; 14:335-345. [PMID: 35899220 PMCID: PMC9309319 DOI: 10.2147/oaem.s342724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Abdominal pain is a common presenting complaint in the emergency department, and utilization of diagnostic imaging is often a key tool in determining its etiology. Plain radiography has limited utility in this population. Computed tomography (CT) is the imaging modality of choice for undifferentiated abdominal pain. Ultrasound and magnetic resonance imaging may be helpful in specific scenarios, primarily in pediatrics and pregnancy, and offer the benefit of eliminating ionizing radiation risk of CT. Guidance for imaging selection is determined by location of pain, special patient considerations, and specific suspected etiologies. Expert guidance is offered by the American College of Radiology Appropriateness Criteria® which outlines imaging options based on location of pain.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, TriStar Skyline Medical Center, Nashville, TN, USA
| | - Maglin Halsey-Nichols
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathryn Ritter
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, New Orleans, LA, USA
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Hong JT, Kutaiba N, Parameswaran B, James S, Hong A, Ng SC, An V. Sensitivity of pre‐operative imaging and radiologist inter‐rater reliability in detecting lesions in Crohn's disease. ANZ J Surg 2022; 92:1085-1090. [DOI: 10.1111/ans.17477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/31/2021] [Accepted: 01/04/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Jason T. Hong
- Department of Colorectal Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Numan Kutaiba
- Department of Radiology (Imaging Associates) Box Hill Hospital Melbourne Victoria Australia
- Department of Radiology Austin Health Melbourne Victoria Australia
| | - Bimal Parameswaran
- Department of Radiology (Imaging Associates) Box Hill Hospital Melbourne Victoria Australia
| | - Simon James
- School of Information Technology Deakin University Geelong Victoria Australia
| | - Alton Hong
- Department of Colorectal Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Suat Chin Ng
- Department of Colorectal Surgery Box Hill Hospital Melbourne Victoria Australia
| | - Vinna An
- Department of Colorectal Surgery Box Hill Hospital Melbourne Victoria Australia
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Dane B, Qian K, Gauvin S, Ji H, Karajgikar J, Kim N, Chang S, Chandarana H, Kim S. Inter-reader agreement of the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus reporting for key phenotypes at MR enterography in adults with Crohn disease: impact of radiologist experience. Abdom Radiol (NY) 2021; 46:5095-5104. [PMID: 34324038 DOI: 10.1007/s00261-021-03229-y] [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: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist experience on inter-reader agreement of CD phenotypes. METHODS Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level. RESULTS All readers had almost-perfect inter-reader agreement (κ > 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (κ: 0.80-0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (κ 0.68 versus 0.96, p = 0.018) and for strictures on follow-up than initial MRE (κ 0.76 versus 1.0, p = 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (κ: 0.55 versus 0.92, p = 0.008). CONCLUSION There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.
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Ahmed EA, Abdelatty K, Mahdy RE, Emara DM, Header DA. Computed tomography enterocolongraphy in assessment of degree of ulcerative colitis activity. Int J Clin Pract 2021; 75:e14626. [PMID: 34258846 DOI: 10.1111/ijcp.14626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Inflammatory bowel diseases are gaining more interest in the past few years. Ulcerative colitis (UC) is a chronic disease that requires accurate follow-up for a good treatment plan. Colonoscopy alone cannot be efficient to detect disease extent and has a high risk of perforation in acute severe UC and toxic megacolon. Computed tomographic enterocolonography (CTE) is widely used now to detect intramural, extra-intestinal involvement and intestinal complications. Hence, this study aimed to evaluate CTE in the assessment of the degree of activity of UC. PATIENTS AND METHODS This cross-sectional study was carried on 50 UC patients, divided into 36 males and 14 females presented at the Gastroenterology Unit, Alexandria Main University, Faculty of Medicine. Assessment of UC activity was done to all patients on three levels; the ulcerative colitis disease activity index for the clinical level, ulcerative colitis endoscopic index of severity by endoscopy and pathologically by degree of neutrophilic invasion, crypt abscess or cryptitis, presence of oedema and mucosal surface ulceration, then CTE was done and the findings were compared with the histopathological findings. Bowel wall thickening in CTE was divided into: normal (<3 mm, score 0), mild (3-6 mm, score 1), moderate (6-9 mm, score 2) and severe (>9 mm, score 3). Mesenteric hyperaemia, mucosal hyper enhancement and enlarged pericolic lymph nodes were recorded. RESULTS CTE findings in the form of bowel wall thickening and hyper enhancement were found in 74% of active cases and were correlated with all histopathological findings investigated in this study with high statistical significance except in chronic stages, whereas lymph node enlargement and mesenteric hyperaemia did not show statistical significance with disease activity. CONCLUSION CTE is a good tool for diagnosing disease activity in UC.
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Affiliation(s)
- Ezzat Ali Ahmed
- Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Khaled Abdelatty
- Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Reem Ezzat Mahdy
- Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Doaa Mohamed Emara
- Radiodiagnosis Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Doaa Abdou Header
- Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ma L, Shen X, Chen YJ, Zhang Q, Li B, Zhang W. Computed tomography enterography for crohn's disease: correlation between the imaging findings and histopathologic scoring system. Abdom Radiol (NY) 2021; 46:4121-4129. [PMID: 33993318 DOI: 10.1007/s00261-021-03112-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim of this study was to retrospectively determine if quantitative measurements of computed tomography enterography (CTE) imaging findings correlate with histopathologic scores from biopsy specimens in patients with Crohn's disease (CD). METHODS CTE datasets of 34 CD patients (19 male and 15 female) who underwent endoscopy with biopsy within 25 days before or after CTE were retrospectively reviewed. CTE findings of segmental mural hyperenhancement, wall thickening, mural stratification and mesenteric findings were quantitatively measured in the corresponding segment. Histopathologic score of CD was based upon the Naini Cortina scoring system. Correlation between CTE findings and histopathologic scores was assessed using Spearman's rank correlation and logistic or linear regression analysis. RESULTS Neutrophilic inflammation contributed the most to the segmental mural hyperenhancement and explained 38.4% of the variance (R2 = 0.384, P = 0.006). Moreover, the increased lymphocytes and plasma cells predicted larger lymph node (P = 0.003) and increased attenuation in mesenteric fat (P = 0.022). CONCLUSIONS To a certain extent, macroscopic CTE findings may reflect the microscopic histopathologic state in the inflammatory stage of CD, underscoring that establishment of CTE scoring system may potentially provide an objective tool for assessment of disease progression.
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Affiliation(s)
- Liang Ma
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, No. 399, Wanyuan Road, Minhang District, Shanghai, 201102, China
| | - Xing Shen
- Department of Radiology, Kunshan Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, No. 189, Chaoyang Road, Kunshan, 215300, Jiangsu Province, China
| | - Yi-Jing Chen
- Department of Pathology, Kunshan Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, No. 189, Chaoyang Road, Kunshan, 215300, Jiangsu Province, China
| | - Qi Zhang
- Department of Blood Transfusion, Huashan Hospital, Fudan University, No. 12, Urumqi Rd, Jing'an District, Shanghai, 200041, China
| | - Bo Li
- Department of Medical Imaging, Renji Hospital, Medical School of Jiaotong University, Shanghai, China, No. 160, Pujian Road, Pudong District, Shanghai, 200127, China.
| | - Wei Zhang
- Department of Medical Imaging, Renji Hospital, Medical School of Jiaotong University, Shanghai, China, No. 160, Pujian Road, Pudong District, Shanghai, 200127, China.
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Stocker D, King MJ, El Homsi M, Carbonell G, Bane O, Cuevas J, Liu Q, Cho J, Doucette JT, Greenstein AJ, Colombel JF, Harpaz N, Taouli B. Luminal Narrowing Alone Allows an Accurate Diagnosis of Crohn's Disease Small Bowel Strictures at Cross-Sectional Imaging. J Crohns Colitis 2021; 15:1009-1018. [PMID: 33319236 DOI: 10.1093/ecco-jcc/jjaa256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Current consensus recommendations define small bowel strictures [SBS] in Crohn's disease [CD] on imaging as luminal narrowing with unequivocal upstream bowel dilation. The aim of this study was to [1] evaluate the performance of cross-sectional imaging for SBS diagnosis in CD using luminal narrowing with upstream SB dilation and luminal narrowing with or without upstream dilation, and [2] compare the diagnostic performance of computed tomography [CT] and magnetic resonance enterography [MRE] for SBS diagnosis. METHODS In total, 111 CD patients [81 with pathologically confirmed SBS, 30 controls] who underwent CT and/or MRE were assessed. Two radiologists [R1, R2] blinded to pathology findings independently assessed the presence of luminal narrowing and upstream SB dilation. Statistical analysis was performed for [1] luminal narrowing with or without SB upstream dilation ['possible SBS'], and [2] luminal narrowing with upstream SB dilation ≥3 cm ['definite SBS']. RESULTS Sensitivity for detecting SBS was significantly higher using 'possible SBS' [R1, 82.1%; R2, 77.9%] compared to 'definite SBS' [R1, 62.1%; R2, 65.3%; p < 0.0001] with equivalent specificity [R1, 96.7%; R2, 93.3%; p > 0.9]. Using the criterion 'possible SBS', sensitivity/specificity were equivalent between CT [R1, 87.3%/93.3%; R2, 83.6%/86.7%] and MRE [R1, 75.0%/100%; R2: 70.0%/100%]. Using the criterion 'definite SBS', CT showed significantly higher sensitivity [78.2%] compared to MRE [40.0%] for R1 but not R2 with similar specificities [CT, 86.7-93.3%; MRE, 100%]. CONCLUSION SBS can be diagnosed using luminal narrowing alone without the need for upstream dilation. CT and MRE show similar diagnostic performance for SBS diagnosis using luminal narrowing with or without upstream dilation.
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Affiliation(s)
- Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Michael J King
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria El Homsi
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Guillermo Carbonell
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Radiology, Virgen de la Arrixaca University Clinical Hospital, University of Murcia, Murcia, Spain
| | - Octavia Bane
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jordan Cuevas
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qingqing Liu
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Judy Cho
- Charles Bronfman Institute for Personalized Medicine, Departments of Genetics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John T Doucette
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jean-Frederic Colombel
- The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Noam Harpaz
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Núñez F P, Krugliak Cleveland N, Quera R, Rubin DT. Evolving role of endoscopy in inflammatory bowel disease: Going beyond diagnosis. World J Gastroenterol 2021; 27:2521-2530. [PMID: 34092973 PMCID: PMC8160621 DOI: 10.3748/wjg.v27.i20.2521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease, encompassing Crohn’s disease (CD) and ulcerative colitis, are chronic immune-mediated inflammatory bowel diseases (IBD) that primarily affect the gastrointestinal tract with periods of activity and remission. Large body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal healing. Mucosal healing has been associated with improved clinical outcomes with prolonged remission, decreased hospitalization, IBD-related surgeries and colorectal cancer risk. Therefore, endoscopic objectives in IBD have been incorporated as part of standard care. With the known increased risk of colorectal cancer in IBD, although prevention strategies continue to develop, regular surveillance for early detection of neoplasia continue to be paramount in IBD patients’ care. It is thanks to evolving technology and visualization techniques that surveillance strategies are continuously advancing. Therapeutic endoscopic options in IBD have also been expanding, from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic lesions. In this review article, we discuss the current evidence on the use of endoscopy as part of standard of care of IBD, its role in surveillance of neoplasia, and the role of interventional endoscopic therapies.
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Affiliation(s)
- Paulina Núñez F
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Santiago 7620157, RM, Chile
- Department of Gastroenterology, Hospital San Juan de Dios, Santiago 8350488, RM, Chile
| | - Noa Krugliak Cleveland
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL 60637, United States
| | - Rodrigo Quera
- Department of Gastroenterology, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Santiago 7620157, RM, Chile
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL 60637, United States
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MRE Evaluation of Intestinal Inflammation: Qualitative and Quantitative Assessment. Top Magn Reson Imaging 2021; 30:13-22. [PMID: 33528208 DOI: 10.1097/rmr.0000000000000270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACT Magnetic resonance enterography (MRE) is a powerful tool for evaluation and management of patients with Crohn disease. Changes of active inflammation of the small bowel can reliably and reproducibly be detected and monitored. Findings indicative of active inflammation include bowel wall thickening, intramural edema and mural hyperenhancement. These changes are most commonly reported qualitatively; however, quantitative indices have also been developed and validated to measure and monitor inflammation both for clinical care and research purposes. This article describes the essential findings of active inflammation on MRE as well as the fundamentals of both qualitative and quantitative assessment and reporting.
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Gonzalez-Montpetit E, Ripollés T, Martinez-Pérez MJ, Vizuete J, Martín G, Blanc E. Ultrasound findings of Crohn's disease: correlation with MR enterography. Abdom Radiol (NY) 2021; 46:156-167. [PMID: 32607648 DOI: 10.1007/s00261-020-02622-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
Crohn's disease is a chronic inflammatory bowel disease characterized by periods of relative inactivity alternating with acute flare-ups. Imaging techniques play a fundamental role in the diagnosis and follow-up of Crohn's disease, providing information on the extent of disease, disease activity, and the presence of extramural complications. Because of the frequent re-evaluation required by the relapsing nature of Crohn's disease and the relative young age at which most patients are diagnosed, techniques that use ionizing radiation are best avoided in monitoring this population. Thus, magnetic resonance enterography (MRE) and ultrasonography (US) are the preferable techniques. Various studies have demonstrated that US is accurate in assessing the gut. Despite some clear advantages over MRE, US has long been underused in the evaluation of intestinal disease. This review presents an overview of the main imaging findings in Crohn's disease, correlating representative US images with MRE and surgical pathology specimens. We conclude that US reliably depicts both bowel-related and mesenteric features of Crohn's disease and US findings correlate strongly with MRE findings.
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Affiliation(s)
- Estefania Gonzalez-Montpetit
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain.
- Abdominal Imaging, Centre IDI Girona, Hospital Universitario Doctor Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain.
| | - Tomás Ripollés
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - María J Martinez-Pérez
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Vizuete
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Gregorio Martín
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Esther Blanc
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
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15
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Gu YB, Zhong J. Endoscopic management of stricturing Crohn's disease. J Dig Dis 2020; 21:351-354. [PMID: 32537911 DOI: 10.1111/1751-2980.12914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022]
Abstract
The natural history of Crohn's disease (CD) usually begins with primary intestinal inflammation, which progresses gradually to stricturing lesions. Stricture is a complicated, intractable but very common clinical problem in the management of CD. Difficulties remain in treating stricturing CD because of the limited efficacy of drug therapy and relapse of stricturing lesions cannot be completely avoided by surgery. Endoscopic management is a bridging therapy between drug therapy and surgical intervention, mainly including endoscopic balloon dilatation and endoscopic stricturotomy, and has been found to be effective for treating stricturing CD. Its explicit curative effect, less invasiveness and high safety performance make endoscopic management more acceptable by both the physician and patient. Although some patients require repeated endoscopic treatment and ultimately cannot avoid surgery, yet it can significantly delay the time to surgery and improve the quality of life. Physicians carrying out the endoscopic procedure need to be trained for performing this procedure. In this review we summarized the diagnosis and endoscopic treatment of stricturing CD.
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Affiliation(s)
- Yu Bei Gu
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zhong
- Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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16
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Cucchiara S, D'Arcangelo G, Isoldi S, Aloi M, Stronati L. Mucosal healing in Crohn's disease: new insights. Expert Rev Gastroenterol Hepatol 2020; 14:335-345. [PMID: 32315209 DOI: 10.1080/17474124.2020.1759416] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Traditional management of patients with Crohn's disease includes symptoms and quality of life improvement. With the advent of biological agents, mucosal healing has become an achievable goal, documented through endoscopy. However, due to the transmural nature of inflammation, the prevention of bowel damage should be included in the aims of a targeted therapeutic strategy. AREAS COVERED Updated literature has been searched in PubMed from 2008 to 2020. This review focuses on the state of the art in the innovative therapeutic goals in Crohn's disease, also considering still controversial aspects and future research topics in the management of Crohn's disease. EXPERT OPINION Although a widely agreed view supports the notion that mucosal healing and bowel damage control may promote beneficial outcomes (i.e. reduction in hospitalization and surgical rates, avoidance of steroids), long-term robust data are still missing. On the other hand, the development of -omics techniques has expanded our knowledge of the pathogenetic mechanism underlying inflammatory bowel disease and opened up new horizons in precision or personalized medicine.
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Affiliation(s)
- Salvatore Cucchiara
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Giulia D'Arcangelo
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Sara Isoldi
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Marina Aloi
- Women's and Children's Health Department, Pediatric Gastroenterology and Hepatology Unit, Sapienza University of Rome , Rome, Italy
| | - Laura Stronati
- Department of Molecular Medicine, Sapienza University of Rome , Rome, Italy
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17
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Kim DH, Chang KJ, Fowler KJ, Cash BD, Garcia EM, Kambadakone AR, Levy AD, Liu PS, Mace SE, Marin D, Moreno C, Peterson CM, Pietryga JA, Solnes LB, Weinstein S, Carucci LR. ACR Appropriateness Criteria® Crohn Disease. J Am Coll Radiol 2020; 17:S81-S99. [PMID: 32370980 DOI: 10.1016/j.jacr.2020.01.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
Abstract
Three common clinical scenarios involving use of imaging in Crohn disease are covered. These include the initial evaluation of Crohn disease when the diagnosis has not been previously established, the evaluation for anticipated exacerbation of known disease, and the evaluation of disease activity during therapy monitoring. The appropriateness of a given imaging modality for each scenario is rated as one of three categories (usually appropriate, may be appropriate, usually not appropriate) to help guide evaluation. Pediatric presentation of Crohn disease and the appropriateness of imaging are not covered in this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin.
| | | | - Kathryn J Fowler
- Panel Vice-Chair, University of California San Diego, San Diego, California
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Evelyn M Garcia
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | | | - Angela D Levy
- Medstar Georgetown University Hospital, Washington, District of Columbia
| | | | - Sharon E Mace
- Cleveland Clinic, Cleveland, Ohio; American College of Emergency Physicians
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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18
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Cantarelli BCF, de Oliveira RS, Alves AMA, Ribeiro BJ, Velloni F, D'Ippolito G. Evaluating inflammatory activity in Crohn's disease by cross-sectional imaging techniques. Radiol Bras 2020; 53:38-46. [PMID: 32313336 PMCID: PMC7159043 DOI: 10.1590/0100-3984.2018.0096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The evaluation of inflammatory bowel activity in patients with Crohn’s disease has traditionally been a challenge, mainly because of the difficulty in gaining endoscopic access to the small bowel. Historically, barium-based contrast studies were the only option for the evaluation of inflammatory activity in Crohn’s disease. They were gradually replaced by cross-sectional imaging techniques, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) now being the modalities of choice for such evaluations. Those two imaging methods have provided important information regarding intestinal wall involvement and extra-intestinal manifestations of Crohn’s disease, not only assessing lesion characteristics and complications but also quantifying inflammatory bowel activity. The objective of this article is to review the main technical aspects of CTE and MRE, together with their indications, contraindications, and limitations, as well as the CTE and MRE imaging characteristics of inflammatory activity in Crohn’s disease.
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Affiliation(s)
| | | | - Aldo Maurici Araújo Alves
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Bruno Jucá Ribeiro
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Fernanda Velloni
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.,Diagnósticos da América S/A, Barueri, SP, Brazil
| | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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19
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Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS, Gee MS, Grajo JR, Huang C, Jaffe TA, Park SH, Rimola J, Soto JA, Taouli B, Taylor SA, Baker ME. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2020; 40:354-375. [DOI: 10.1148/rg.2020190091] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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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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21
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Hakim A, Alexakis C, Pilcher J, Tzias D, Mitton S, Paul T, Saxena S, Pollok R, Kumar S. Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in pediatric Crohn's disease. JGH OPEN 2019; 4:126-131. [PMID: 32280754 PMCID: PMC7144762 DOI: 10.1002/jgh3.12228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/29/2019] [Accepted: 06/30/2019] [Indexed: 12/23/2022]
Abstract
Aim To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of pediatric patients investigated for Crohn's disease (CD) attending a UK tertiary center. Methods and Results Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy (IC), and MRE. The accuracy and agreement of SICUS in detecting small bowel lesions and CD-related complications were assessed using kappa (κ) coefficient statistics. A total of 93 patients (median age 15 years, range 2-17, 49 male) underwent SICUS; 58 had suspected and 35 had established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8 and 100% and for TUS 85.7 and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7 and 100% and TUS 80 and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ = 0.73) but fair in TUS (κ = 0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ = 0.84), with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ = 0.63) and moderate (κ = 0.53), respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ = 0.77) and dilatation (κ = 0.68). Conclusions SICUS offers a radiation-free alternative for assessing pediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.
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Affiliation(s)
| | - Christopher Alexakis
- Department of Gastroenterology St George's University Hospitals NHS Foundation Trust London UK
| | - James Pilcher
- Department of Radiology St George's University Hospitals NHS Foundation Trust London UK
| | - Demitrios Tzias
- Department of Radiology St George's University Hospitals NHS Foundation Trust London UK
| | - Sally Mitton
- Department of Paediatric Gastroenterology St George's University Hospitals NHS Foundation Trust London UK
| | - Thankam Paul
- Department of Paediatric Gastroenterology St George's University Hospitals NHS Foundation Trust London UK
| | - Sonia Saxena
- Child Health Unit, School of Public Health Imperial College London London UK
| | - Richard Pollok
- Medical School St George's Hospital London UK.,Department of Gastroenterology St George's University Hospitals NHS Foundation Trust London UK
| | - Shankar Kumar
- Centre for Medical Imaging University College London London UK
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22
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The Role of the Radiologist in Determining Disease Severity in Inflammatory Bowel Diseases. Gastrointest Endosc Clin N Am 2019; 29:447-470. [PMID: 31078247 DOI: 10.1016/j.giec.2019.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Crohn's disease and ulcerative colitis are chronic inflammatory diseases that lead to progressive bowel damage including the development of stricturing and penetrating complications. Increasingly, cross-sectional imaging with computed tomography or magnetic resonance scans have emerged as leading tools to: (1) assess disease activity; (2) monitor response to therapy or disease recurrence; and (3) identify disease-related complications. Several validated radiological scoring systems have been developed to quantify cross-sectional and longitudinal inflammatory burden in these diseases and to monitor response to treatment. Bowel ultrasound is also a simple and inexpensive tool but is operator dependent in its performance.
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23
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Yuksel I, Kilincalp S, Coskun Y, Akinci H, Hamamci M, Alkan A. Diagnostic accuracy of intestinal ultrasound and magnetic resonance enterography for the detection of endoscopy-based disease activity in ileocolonic Crohn's disease. Eur J Gastroenterol Hepatol 2019; 31:809-816. [PMID: 31094855 DOI: 10.1097/meg.0000000000001438] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Crohn's disease (CD) is characterised by chronic gastrointestinal inflammation with relapsing-remitting behaviour and often requires endoscopic and/or radiologic assessment. OBJECTIVE The objective of this study was to compare the diagnostic accuracy of intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) for the assessment of disease activity in CD using a simple endoscopic score for CD as a reference standard. PATIENTS AND METHODS A prospective observational study was carried out in 71 consecutive adult patients with known CD, attending our tertiary inflammatory bowel disease clinic, between November 2014 and July 2016. Ileocolonoscopy, IUS and MRE were performed within 1 month prospectively. The simple endoscopic score-CD 0-2 was accepted as remission. RESULTS The sensitivity of IUS and MRE for detecting endoscopic activity was found similar with regard to bowel wall thickening and mesenteric fibrofatty proliferation (P>0.05). The overall accuracy for detecting mural lesions was similar between IUS and MRE. When mural lesions were analysed, the sensitivity of MRE in detecting the loss of wall stratification and stenosis was significantly higher than IUS (P<0.001 for both). IUS showed higher specificity for bowel wall thickening, loss of wall stratification and stenosis (P=0.009, P<0.001 and P<0.001, respectively). Sensitivity and accuracy of IUS were higher in detecting ascites in active disease (P=0.002). DISCUSSION Our results showed that IUS and MRE were equally accurate in detecting endoscopic activity. IUS may be the preferred technique for the evaluation of disease activity and for the follow-up of CD.
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Affiliation(s)
- Ilhami Yuksel
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital
- Department of Gastroenterology
| | - Serta Kilincalp
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital
| | - Yusuf Coskun
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital
| | - Hakan Akinci
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital
| | - Mevlut Hamamci
- Department of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital
| | - Afra Alkan
- Department of Biostatistics and Medical Informatics, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
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24
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Varyani F, Samuel S. "Can Magnetic Resonance Enterography (MRE) replace ileo-colonoscopy for evaluating disease activity in Crohn's disease?". Best Pract Res Clin Gastroenterol 2019; 38-39:101621. [PMID: 31327407 DOI: 10.1016/j.bpg.2019.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/23/2019] [Indexed: 01/31/2023]
Abstract
Crohn's disease is a form of chronic inflammatory bowel disease that can lead to structural bowel damage due to transmural inflammation. Ileo-colonosocopy is currently essential for initial diagnosis. Reassessment of disease burden is frequently needed during episodes of active disease and when evaluating treatment efficacy. This review compares the role of Magnetic Resonance Enterography (MRE) and ileocolonoscopy in Crohn's disease management and whether cross-sectional imaging can replace invasive endoscopic tests. MRE can give information on the small bowel not visible at ileo-colonoscopy, and on extra-luminal complications. Evaluation of the bowel by MRE allows assessment of the submucosa and serosa, and thus transmural healing. MRE offers a well tolerated investigation and additional information on disease activity to better manage patients with Crohn's disease. Increasingly, there are a range of newer techniques such as diffusion weighted imaging, magnetisation transfer and motility MRI which provide greater information on fibrosis and predictors to treatment response which has been lacking despite the use of ileo-colonoscopy for several decades.
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Affiliation(s)
- Fumi Varyani
- NIHR Nottingham Biomedical Medical Centre, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom
| | - Sunil Samuel
- NIHR Nottingham Biomedical Medical Centre, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom.
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25
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Abstract
Acute abdominopelvic pain, a common symptom in emergency department patients, is challenging given the spectrum of differential diagnoses encompassing multiple organ systems, ranging from benign self-limiting to life-threatening and emergent. Diagnostic imaging is critical given its high accuracy and management guidance. A contrast-enhanced computed tomography (CT) scan is preferred given its widespread availability and speed of acquisition. MR imaging may be appropriate, usually performed for specific indications with tailored protocols. It is accurate for diagnosis and may be an alternative to CT. This article discusses the advantages and disadvantages, protocols, and appearances of MR imaging of common diagnoses.
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Affiliation(s)
- Jennifer W Uyeda
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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26
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Jones GR, Fascì-Spurio F, Kennedy NA, Plevris N, Jenkinson P, Lyons M, Wong L, MacLean P, Glancy S, Lees CW. Faecal Calprotectin and Magnetic Resonance Enterography in Ileal Crohn's Disease: Correlations Between Disease Activity and Long-Term Follow-Up. J Crohns Colitis 2019; 13:442-450. [PMID: 30452618 DOI: 10.1093/ecco-jcc/jjy187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Magnetic resonance enterography [MRE] is the gold standard for assessing ileal inflammation in Crohn's disease [CD]. The aim of the present study was to correlate faecal calprotectin [FC] to MRE via a simple score in an exclusive ileal cohort with long-term follow-up for association with time to surgery or biologic therapy. METHODS In total, 150 MRE studies with matched FC [±30 days] were identified from the Edinburgh FC Register [2008-12; n = 18138]. Scans were re-read blinded to clinical data, independently, by two expert gastrointestinal radiologists, to generate a simple MRE score [range 0-10] from assessment of the worst intestinal segment plus total disease extent. RESULTS In total, 119 MRE scans were evaluated from 104 patients with ileal CD [L1 or L3 with panproctocolectomy]. Receiver operating characteristic analysis showed an area under the curve of 0.77 [0.67-0.87, p < 0.0001] for FC and MRE score >1, with an optimal cut-off of 145 μg/g for severe inflammation on MRE with 69.3% [57.6-79.5] sensitivity and 71.4% [53.7-85.4] specificity. Long-term follow-up over a median [interquartile range] of 2086 days [1786-2353] revealed FC ≥ 145 μg/g was associated with reduced biologic-free survival until 3 years following MRE, whereas MRE score [severe vs absent] was associated with reduced surgery- and biologic-free survival throughout follow-up. Backwards stepwise logistic regression revealed that length of ileal disease (odds ratio [OR] 3.8, 1.1-13.2, p = 0.034) and increased bowel wall thickness at MRE [OR 4.2, 1.6-10.7, p < 0.0001] or female sex [OR 5.2, 1.5-18.7, p = 0.011] increased the risk of biologic use or surgery, respectively. CONCLUSIONS FC correlates well with MRE assessment of ileal CD with MRE parameters associated with long-term biologic- and surgery-free remission.
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Affiliation(s)
- G R Jones
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
| | - F Fascì-Spurio
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,Sapienza University, Gastroenterology Unit, Rome, Italy
| | - N A Kennedy
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
| | - N Plevris
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - P Jenkinson
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - M Lyons
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK
| | - L Wong
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - P MacLean
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - S Glancy
- Western General Hospital, Department of Radiology, Edinburgh, UK
| | - C W Lees
- Western General Hospital, Gastrointestinal Unit, Edinburgh, UK.,University of Edinburgh, Gastrointestinal Unit, Centre for Genomic and Experimental Medicine, Edinburgh, UK
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27
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Rees MA, Dillman JR, Anton CG, Rattan MS, Smith EA, Towbin AJ, Zhang B, Trout AT. Inter-radiologist agreement using Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus nomenclature for reporting CT and MR enterography in children and young adults with small bowel Crohn disease. Abdom Radiol (NY) 2019; 44:391-397. [PMID: 30120514 DOI: 10.1007/s00261-018-1743-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To assess inter-radiologist agreement using the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus recommendations for reporting CT/MR enterography exams in pediatric and young adult small bowel Crohn disease (CD). METHODS Institutional review board approval was obtained for this HIPAA-compliant retrospective investigation; the requirement for informed consent was waived. 25 CT and 25 MR enterography exams performed in children and young adults (age range: 6-23 years) between January 2015 and April 2017 with a distribution of ileal CD severity (phenotype) were identified: normal or chronic CD without active inflammation (40%), active inflammatory CD (20%), stricturing CD (20%), and penetrating CD (20%). Five fellowship-trained pediatric radiologists, blinded to one another, documented key imaging findings and standardized impressions based on SAR-AGA consensus recommendations. Inter-radiologist agreement was evaluated using Fleiss' multi-rater kappa statistic (κ) with 95% confidence intervals (CI). RESULTS Inter-radiologist agreement was moderate for all key imaging findings except presence of ulcerations (κ 0.37 [95% CI 0.28-0.46]) and sacculations (κ 0.31 [95% CI 0.23-0.40]). Agreement for standardized impressions was substantial for stricturing disease (κ 0.79 [95% CI 0.70-0.87]) and moderate for presence of inflammation (κ 0.49 [95% CI 0.44-0.56]) and penetrating disease (κ 0.58 [95% CI 0.49-0.67]). No significant difference in agreement was found between CT and MRI. CONCLUSIONS Agreement among five pediatric radiologists was moderate to substantial for SAR-AGA standardized impressions and fair to moderate for key imaging findings of pediatric and young adult CD.
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Affiliation(s)
- Mitchell A Rees
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Christopher G Anton
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Mantosh S Rattan
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Ethan A Smith
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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28
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Deepak P, Fowler KJ, Fletcher JG, Bruining DH. Novel Imaging Approaches in Inflammatory Bowel Diseases. Inflamm Bowel Dis 2019; 25:248-260. [PMID: 30010908 DOI: 10.1093/ibd/izy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel diseases are chronic autoimmune conditions of the gastrointestinal tract, mainly grouped into ulcerative colitis or Crohn's disease. Traditionally, symptoms have been used to guide IBD management, but this approach is fatally flawed, as symptoms don't correlate with disease activity and often fail to predict disease complications, especially with Crohn's disease. Hence, there is increasing recognition of the need for treatment algorithms based on objective measures of bowel inflammation. In this review, we will focus on advancements in the endoscopic and radiological imaging armamentarium that allow detailed assessments from intestinal mucosa to mesentery.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology, John T. Milliken Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Kathryn J Fowler
- Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
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Jia Y, Li C, Yang X, Dong Z, Huang K, Luo Y, Li X, Sun C, Feng ST, Li ZP. CT Enterography score: a potential predictor for severity assessment of active ulcerative colitis. BMC Gastroenterol 2018; 18:173. [PMID: 30413186 PMCID: PMC6230286 DOI: 10.1186/s12876-018-0890-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evaluate the possibility of CT enterography (CTE) score system as a predictor in assessing active ulcerative colitis (UC) severity. METHODS Forty-six patients with active UC with CTE and colonoscopy were enrolled. Based on modified Mayo score, patients were divided into three groups: mild (n = 10), moderate (n = 17) and severe (n = 19). A cumulative CTE score was calculated in each patient and its correlation with modified Mayo score was analyzed. The optimal cutoff values of CTE score were determined by receiver operating characteristic (ROC) curves analysis. RESULTS Significant between-group differences were observed in CTE spectrums of mucosal bubbles, mural stratification, loss of haustration, enlarged mesenteric lymph nodes and engorged mesenteric vessels (P < 0.05). The cumulative CTE scores were significant difference between three groups (CTE score:4.9 ± 2.3, 7.6 ± 2.6, and 10.9 ± 2.0, respectively, P < 0.01). The cumulative CTE score showed a positive correlation with modified Mayo score (r = 0.835, P < 0.05). The optimal cut-off value for CTE score predicting moderate and severe UC was 9.5 (area under the curve [AUC]:0.847, sensitivity:78.9%, specificity:82.4%). CONCLUSION Disease severity assessment by CTE score demonstrates strong positive correlation with severity established modified Mayo score. CTE score system maybe a potential predictor for active UC severity assessment.
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Affiliation(s)
- Yingmei Jia
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Chang Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Xiaoyan Yang
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518000, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Kun Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Canhui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Zi-Ping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th, The Second Zhongshan Road, Guangzhou, 510080, Guangdong, China.
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30
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Deepak P, Fletcher JG, Fidler JL, Barlow JM, Sheedy SP, Kolbe AB, Harmsen WS, Therneau T, Hansel SL, Becker BD, Loftus EV, Bruining DH. Predictors of Durability of Radiological Response in Patients With Small Bowel Crohn's Disease. Inflamm Bowel Dis 2018; 24:1815-1825. [PMID: 29668921 PMCID: PMC6391864 DOI: 10.1093/ibd/izy074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND The long-term significance of radiological transmural response (TR) as a treatment goal at the first follow-up scan in small bowel Crohn's disease (CD) has been previously shown. We examined the durability of a long-term strategy of treating to a target of radiological TR and the influence of baseline predictors on the maintenance of TR. METHODS Small bowel CD patients between January 1, 2002, and December 31, 2014, were identified with serial computed tomography enterography (CTE)/magnetic resonance enterography (MRE) before and after initiation of therapy or on maintenance therapy. Overall TR (inflammatory lesions with/without strictures) w1as characterized by abdominal radiologists in up to 5 small bowel lesions per patient at each serial scan until last follow-up or small bowel resection, as response, partial response, or nonresponse. The rate of conversion between TR states and transition to surgery, including the effect of baseline patient/disease characteristics, was examined using a multistate model (mstate R-package). RESULTS CD patients (n = 150, 705 CTE/MRE) with a median of 4 CTE/MRE during 4.6 years of follow-up, 49% with ileal-only distribution, had 260 examined bowel segments. Conversion from response to partial response/nonresponse was 37.4% per year of follow-up with no transitions seen directly from response to surgery. Current smoking status (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.1-4.3) and internal penetrating disease at baseline scan (HR, 2.2; 95% CI, 1.2-4.1) were associated with a 2-fold increased risk of transition from partial response/nonresponse to surgery. CONCLUSIONS Achievement and maintenance of radiological response is associated with avoidance of small bowel surgery. Continued follow-up with CTE/MRE is recommended to identify loss of response, especially in current smokers and patients with internal penetrating disease at baseline CTE/MRE.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota,Department of Medicine, Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jeff L Fidler
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John M Barlow
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Shannon P Sheedy
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Amy B Kolbe
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - William S Harmsen
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Terry Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie L Hansel
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Brenda D Becker
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota,Address correspondence to: David H. Bruining, MD, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905 ()
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Abstract
MRI has transformed from the theoretical, investigative realm to mainstream clinical medicine over the past four decades and has become a core component of the diagnostic toolbox in the practice of gastroenterology (GI). Its success is attributable to exquisite contrast and the ability to isolate specific proton species through the use of different pulse sequences (i.e., T1-weighted, T2-weighted, diffusion-weighted) and exploiting extracellular and hepatobiliary contrast agents. Consequently, MRI has gained preeminence in various GI clinical applications: liver and pancreatic lesion evaluation and detection, liver transplantation evaluation, pancreatitis evaluation, Crohn's disease evaluation (using MR enterography) rectal cancer staging and perianal fistula evaluation. MR elastography, in concert with technical innovations allowing for fat and iron quantification, provides a noninvasive approach, or "MRI virtual liver biopsy" for diagnosis and management of chronic liver diseases. In the future, the arrival of ultra-high-field MR systems (7 T) and the ability to perform magnetic resonance spectroscopy in the abdomen promise even greater diagnostic insight into chronic liver disease.
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Bruining DH, Zimmermann EM, Loftus EV, Sandborn WJ, Sauer CG, Strong SA. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Gastroenterology 2018; 154:1172-1194. [PMID: 29329905 DOI: 10.1053/j.gastro.2017.11.274] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented.
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Affiliation(s)
- David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Ellen M Zimmermann
- Department of Gastroenterology, University of Florida, Gainesville, Florida
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Cary G Sauer
- Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Scott A Strong
- Division of GI Surgery, Northwestern Medicine, Chicago, Illinois
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33
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Bruining DH, Zimmermann EM, Loftus EV, Sandborn WJ, Sauer CG, Strong SA. Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn's Disease. Radiology 2018; 286:776-799. [PMID: 29319414 DOI: 10.1148/radiol.2018171737] [Citation(s) in RCA: 162] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Computed tomography and magnetic resonance enterography have become routine small bowel imaging tests to evaluate patients with established or suspected Crohn's disease, but the interpretation and use of these imaging modalities can vary widely. A shared understanding of imaging findings, nomenclature, and utilization will improve the utility of these imaging techniques to guide treatment options, as well as assess for treatment response and complications. Representatives from the Society of Abdominal Radiology Crohn's Disease-Focused Panel, the Society of Pediatric Radiology, the American Gastroenterological Association, and other experts, systematically evaluated evidence for imaging findings associated with small bowel Crohn's disease enteric inflammation and established recommendations for the evaluation, interpretation, and use of computed tomography and magnetic resonance enterography in small bowel Crohn's disease. This work makes recommendations for imaging findings that indicate small bowel Crohn's disease, how inflammatory small bowel Crohn's disease and its complications should be described, elucidates potential extra-enteric findings that may be seen at imaging, and recommends that cross-sectional enterography should be performed at diagnosis of Crohn's disease and considered for small bowel Crohn's disease monitoring paradigms. A useful morphologic construct describing how imaging findings evolve with disease progression and response is described, and standard impressions for radiologic reports that convey meaningful information to gastroenterologists and surgeons are presented. ©2018, RSNA, AGA Institute, and Society of Abdominal Radiology This article is being published jointly in Radiology and Gastroenterology.
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Affiliation(s)
- David H Bruining
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
| | - Ellen M Zimmermann
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
| | - Edward V Loftus
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
| | - William J Sandborn
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
| | - Cary G Sauer
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
| | - Scott A Strong
- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
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- From the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn (D.H.B., E.V.L); Department of Gastroenterology, University of Florida, Gainesville, Fla (E.M.Z.); Division of Gastroenterology, University of California San Diego, San Diego, Calif (W.J.S); Division of Pediatric Gastroenterology, Emory University, Children's Healthcare of Atlanta, Ga (C.G.S); and Division of GI Surgery, Northwestern Medicine, Chicago, Ill (S.A.S)
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Isolated Acute Terminal Ileitis Without Preexisting Inflammatory Bowel Disease Rarely Progresses to Crohn's Disease. Dig Dis Sci 2017; 62:3557-3562. [PMID: 29064015 DOI: 10.1007/s10620-017-4803-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/10/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Isolated acute terminal ileitis without chronic features of inflammation poses a diagnostic challenge. Few studies have investigated the clinical significance of this entity in patients without history of inflammatory bowel disease. AIMS We sought to elucidate the long-term prognosis of patients with isolated acute terminal ileitis, its rate of progression to Crohn's disease, and the factors associated with terminal ileitis development to Crohn's disease. METHODS Retrospective review of clinical, endoscopic, and radiographic records was performed on 108 patients with histologic evidence of isolated acute terminal ileitis on terminal ileal biopsies obtained by diagnostic ileocolonoscopy performed between January 1, 2002, and December 31, 2014, at the Mayo Clinic. Statistical analysis was performed with Student's t test and Fisher's exact test to identify the factors associated with the progression of isolated acute terminal ileitis to Crohn's disease. RESULTS The median follow-up time across 108 patients was 54.7 months (interquartile range 32.0-89.0 months). Five patients (4.6%) developed Crohn's disease after a median of 32.3 months (7.5-43.2 months). The presence of narrowing/stricturing (p = 0.03) on abdominal cross-sectional imaging at the time of terminal ileitis diagnosis was correlated with eventual Crohn's disease development. No significant correlation was found with clinical symptoms, endoscopic features, laboratory testing, NSAID use, smoking history, or family history of inflammatory bowel disease. CONCLUSIONS Isolated acute terminal ileitis discovered on diagnostic ileocolonoscopy rarely develops to Crohn's disease. Presence of stricturing/narrowing on cross-sectional imaging may predict eventual Crohn's disease development.
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Bekendam MIJ, Puylaert CAJ, Phoa SKSS, Nio CY, Stoker J. Shortened oral contrast preparation for improved small bowel distension at MR enterography. Abdom Radiol (NY) 2017; 42:2225-2232. [PMID: 28393302 PMCID: PMC5556127 DOI: 10.1007/s00261-017-1133-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose Adequate small bowel distension in MR enterography is important for the evaluation of disease activity in Crohn’s disease patients. While distension of the distal small bowel can be achieved using standard oral contrast preparation, proximal small bowel distension remains a common impediment. The aim of this study was to compare small bowel distension between a 60-min oral contrast preparation and a 45-min oral contrast preparation. Methods Fifty retrospectively included patients with a 60-min oral preparation protocol and 50 prospectively included patients with a 45-min three-portion oral preparation protocol were included in the study. Both groups gradually ingested a total of 1600 mL 2% Mannitol solution during the preparation time. Two observers independently graded distension of the stomach, duodenum, jejunum, ileum, and (neo-) terminal ileum. Total small bowel distension was calculated as the sum of all small bowel segment scores. Individual and averaged observer distension scores were compared between both groups of patients using χ2 test for ordinal variables. Results Significant differences in distension for one of both observers in favor of the 45-min protocol were found for the stomach (p = 0.04), duodenum (p = 0.02), jejunum (p = 0.02), and total small bowel (p = 0.02). When distension scores were averaged between observers, the stomach, jejunum, and total small bowel showed a significant difference in favor of the 45-min protocol (p = 0.04, 0.02, and 0.02, respectively). Conclusion We advise to use a 45-min three-portion oral preparation protocol for MR enterography for improved overall small bowel distension, proximal small bowel distension, and especially jejunal distension.
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Affiliation(s)
- M I J Bekendam
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - C A J Puylaert
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - S K S S Phoa
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - C Y Nio
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Dirrenberger B, Clerc-Urmès I, Germain A, Bresler L, Olivera P, Martelli L, Danese S, Baumann C, Laurent V, Peyrin-Biroulet L. Value of cross-sectional imaging in assessing active Crohn's disease before stoma reversal. Dig Liver Dis 2017; 49:864-871. [PMID: 28454853 DOI: 10.1016/j.dld.2017.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are currently no guidelines on the need to assess disease activity before stoma reversal in Crohn's disease (CD). We sought to determine the value of cross-sectional imaging for detecting active CD before stoma reversal. METHODS 38 CD patients underwent cross-sectional imaging before stoma reversal. CD activity was blindly evaluated by an independent radiologist. Postoperative outcomes were recorded. RESULTS Before stoma reversal, cross-sectional imaging identified active CD in 20 of the 38 study participants (52.6%). In 9 out of 10 tested patients, radiologic and endoscopic assessments gave concordant findings with regard to CD recurrence before stoma reversal. Stoma reversal was delayed in half of the patients with active CD and in none of the patients without active CD. Before stoma reversal, tumor necrosis factor alpha antagonists or immunosuppressants were initiated in 45% of the patients with active CD and 5.6% of the patients without active CD. In the year following stoma reversal, the recurrence rate (in a radiologic assessment) was higher in patients with active CD than in patients without active CD (75.0% vs. 30.8%, respectively; p=0.04). CONCLUSION Cross-sectional imaging revealed postoperative recurrence in about a quarter of patients before stoma reversal; this finding may influence the postoperative treatment strategy and outcomes.
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Affiliation(s)
- Bastien Dirrenberger
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Medical Center, Lorraine University, Nancy, France
| | - Isabelle Clerc-Urmès
- ESPRI-BioBase Unit, PARC Clinical Research Support Facility, Nancy University Medical Center, Nancy, France
| | - Adeline Germain
- Department of Digestive Surgery, Nancy University Medical Center, Nancy, France
| | - Laurent Bresler
- Department of Digestive Surgery, Nancy University Medical Center, Nancy, France
| | - Pablo Olivera
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Medical Center, Lorraine University, Nancy, France
| | - Laura Martelli
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Medical Center, Lorraine University, Nancy, France
| | | | - Cédric Baumann
- ESPRI-BioBase Unit, PARC Clinical Research Support Facility, Nancy University Medical Center, Nancy, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Medical Center, Nancy, France
| | - Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepatogastroenterology, Nancy University Medical Center, Lorraine University, Nancy, France.
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Deepak P, Park SH, Ehman EC, Hansel SL, Fidler JL, Bruining DH, Fletcher JG. Crohn's disease diagnosis, treatment approach, and management paradigm: what the radiologist needs to know. Abdom Radiol (NY) 2017; 42:1068-1086. [PMID: 28210767 DOI: 10.1007/s00261-017-1068-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Crohn's disease is one of the major subtypes of idiopathic inflammatory bowel disease and is characterized by chronic transmural intestinal inflammation of the gastrointestinal tract anywhere from mouth to the anus, with a predilection for the small bowel. Cross-sectional imaging with computed tomography and magnetic resonance enterography plays a key role in confirming diagnosis, identifying and managing complications, assessing disease severity, and identifying response to medical therapy. This review will focus on the role of radiologists in the diagnosis and assessment of Crohn's disease. Additionally, a review of current medical therapy approaches, available medications, and side effects will be discussed. The review will also highlight key complications of medical therapy and associated diseases that should be evaluated by the radiologist with cross-sectional imaging.
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Affiliation(s)
- Parakkal Deepak
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sang Hyoung Park
- Department of Gastroenterology, Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eric C Ehman
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA
| | - Stephanie L Hansel
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Jeff L Fidler
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Joel G Fletcher
- Division of Abdominal Imaging, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN, 55905, USA.
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Mocci G, Migaleddu V, Cabras F, Sirigu D, Scanu D, Virgilio G, Marzo M. SICUS and CEUS imaging in Crohn's disease: an update. J Ultrasound 2017; 20:1-9. [PMID: 28298939 DOI: 10.1007/s40477-016-0230-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/07/2016] [Indexed: 12/21/2022] Open
Abstract
Endoscopy remains the main technique in the diagnosis and treatment of Crohn's disease (CD); nevertheless, the recent development of innovative and non-invasive imaging techniques has led to a new tool in the exploration of small bowel in CD patients. This paper reviews the available data on ultrasound imaging used for the evaluation of CD, highlighting the role of small intestine contrast-enhanced ultrasonography with the use of oral and intravenous contrast agents.
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Affiliation(s)
| | - Vincenzo Migaleddu
- Sardinian Mediterranean Imaging Research Group, SMIRG No-profit Foundation, Via Gorizia 11, 07100 Sassari, Italy
| | | | - Danilo Sirigu
- Sardinian Mediterranean Imaging Research Group, SMIRG No-profit Foundation, Via Gorizia 11, 07100 Sassari, Italy
| | - Domenico Scanu
- Sardinian Mediterranean Imaging Research Group, SMIRG No-profit Foundation, Via Gorizia 11, 07100 Sassari, Italy
| | - Giuseppe Virgilio
- Sardinian Mediterranean Imaging Research Group, SMIRG No-profit Foundation, Via Gorizia 11, 07100 Sassari, Italy
| | - Manuela Marzo
- Sardinian Mediterranean Imaging Research Group, SMIRG No-profit Foundation, Via Gorizia 11, 07100 Sassari, Italy
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Yamamoto-Furusho J, Bosques-Padilla F, de-Paula J, Galiano M, Ibañez P, Juliao F, Kotze P, Rocha J, Steinwurz F, Veitia G, Zaltman C. Diagnosis and treatment of inflammatory bowel disease: First Latin American Consensus of the Pan American Crohn's and Colitis Organisation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2017. [DOI: 10.1016/j.rgmxen.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Rondonotti E, Koulaouzidis A, Yung DE, Reddy SN, Georgiou J, Pennazio M. Neoplastic Diseases of the Small Bowel. Gastrointest Endosc Clin N Am 2017; 27:93-112. [PMID: 27908521 DOI: 10.1016/j.giec.2016.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The incidence of small bowel tumors is increasing over time. Until recently, their diagnosis was delayed and it was often reached only at the time of surgery. New diagnostic tools, such as capsule endoscopy, device-assisted enteroscopy, and dedicated small bowel cross-sectional imaging techniques, have been introduced recently in clinical practice. The combination of these tools allows medical practitioners to detect small bowel tumors at an early stage and to reach a definite diagnosis before surgery, thus enabling minimally invasive treatments.
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Affiliation(s)
| | - Anastasios Koulaouzidis
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Diana E Yung
- Centre for Liver & Digestive Disorders, The Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Surekha N Reddy
- Department of Radiology, Western General Hospital, Crewe Road South, 51 Little France Crescent, Edinburgh EH3 9JD, UK
| | - Julius Georgiou
- Department of Electrical and Computer Engineering, University of Cyprus, Cyprus 1 University Avenue, Aglantzia 2109, Cyprus
| | - Marco Pennazio
- Division of Gastroenterology U, San Giovanni AS University-Teaching Hospital, Via Cavour 31, Torino 10123, Italy
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Yamamoto-Furusho J, Bosques-Padilla F, de-Paula J, Galiano M, Ibañez P, Juliao F, Kotze P, Rocha J, Steinwurz F, Veitia G, Zaltman C. Diagnóstico y tratamiento de la enfermedad inflamatoria intestinal: Primer Consenso Latinoamericano de la Pan American Crohn's and Colitis Organisation. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2017; 82:46-84. [PMID: 27979414 DOI: 10.1016/j.rgmx.2016.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/23/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
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Abstract
Therapeutic advances in the management of IBD have led to a paradigm shift in the assessment of IBD disease activity. Beyond clinical remission, objective assessment of inflammation is now critical to guiding subsequent therapy as part of a 'treat to target' strategy. Multiple domains of disease activity assessment in IBD exist, each of which has its merits, although none are perfect. The aim of this Review is to comprehensively evaluate measures of disease activity in both ulcerative colitis and Crohn's disease, including clinical, endoscopic, histological and radiological assessment tools, as well as the use of biomarkers and quality of life evaluation. A subjective appraisal of the best indices for use in clinical practice is provided, based on index validation, responsiveness and experience in clinical trials, international specialist opinion, and practicality and suitability for use in clinical practice. This Review aims to enable the reader to gain confidence in IBD disease activity assessment and to give ready access to the necessary tools.
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Computed Tomography and Magnetic Resonance Enterography in Crohn's Disease: Assessment of Radiologic Criteria and Endpoints for Clinical Practice and Trials. Inflamm Bowel Dis 2016; 22:2280-8. [PMID: 27508513 PMCID: PMC4992454 DOI: 10.1097/mib.0000000000000845] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Early recognition of Crohn's disease with initiation of disease-modifying therapy has emerged as a prominent inflammatory bowel disease management strategy. Clinical practice and trials have often focused on patient symptoms, and more recently, serologic tests, stool inflammatory markers, and/or endoscopic inflammatory features for study entry criteria, treatment targets, disease activity monitoring, and to assess therapeutic response. Unfortunately, patient symptoms do not correlate well with biological disease activity, and endoscopy potentially misses or underestimates disease extent and severity in small bowel Crohn's disease. Computed tomography enterography and magnetic resonance enterography (MRE) are potential tools to identify and quantify transmural structural damage and disease activity in the small bowel. In this review, we discuss the role of computed tomography enterography and MRE in disease management algorithms in clinical practice. We also compare the currently developed MRE-based scoring systems, their strengths and pitfalls, as well as the role for MRE in clinical trials for Crohn's disease.
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Rodrigues-Pinto E, Cardoso H, Rosa B, Santos-Antunes J, Rodrigues S, Marques M, Lopes S, Albuquerque A, Carvalho P, Moreira M, Cotter J, Macedo G. Development of a predictive model of Crohn's disease proximal small bowel involvement in capsule endoscopy evaluation. Endosc Int Open 2016; 4:E631-6. [PMID: 27556069 PMCID: PMC4993902 DOI: 10.1055/s-0042-106961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/11/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND STUDY AIMS One of the indications for capsule endoscopy (CE) is the detection of proximal small bowel (SB) involvement in Crohn's disease (CD) patients. Our aim was to assess clinical, laboratory and endoscopic predictors associated with proximal SB involvement in CD patients submitted to CE. PATIENTS AND METHODS Retrospective multicenter study in which Lewis score (LS) was systematically determined in 190 CE of patients diagnosed with CD between 2003 and 2014. RESULTS Significant inflammatory activity (LS > 135) was present in 23 % of the patients in the first tertile and in 31 % of the patients in the second tertile. Albumin, haemoglobin, and total proteins were significantly lower in patients with a LS > 790 compared to patients with a LS < 135, while white blood cell counts and C-reactive protein were significantly higher. In the univariable analysis, a higher risk for proximal SB involvement at CE was associated with ileal involvement at ileocolonoscopy (OR 2.858, P = 0.006), higher platelets levels (OR 1.005, P = 0.004) and significant weight loss (OR 2.450, P = 0.006). In logistic regression, ileal involvement at ileocolonoscopy (OR 6.817, P = 0.003), stricturing behavior (OR 8.653, P = 0.011) and significant weight loss (OR 3.629, P = 0.028) were independently associated with proximal SB involvement at CE. Considering the ROC curve of this model, a cut-off > 0.249 predicts proximal SB involvement with 90 % sensitivity and 40 % specificity (AUROC 0.732). CONCLUSIONS One-third of patients had proximal SB involvement. Predictive factors were significant weight loss, stricturing behaviour, and ileal involvement at ileocolonoscopy. These data help to select CD patients that benefit the most from performing a CE.
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Affiliation(s)
- Eduardo Rodrigues-Pinto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal,Corresponding author Eduardo Rodrigues-Pinto, MD Gastroenterology DepartmentCentro Hospitalar São JoãoPorto. Al. Prof. Hernâni Monteiro 4200 - 319 PortoPortugal+351 919657386+351 22 551 3601
| | - Helder Cardoso
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Bruno Rosa
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | | | - Susana Rodrigues
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Margarida Marques
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Susana Lopes
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Pedro Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Maria Moreira
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
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Boal Carvalho P, Cotter J. Contrast-Enhanced Cross Sectional Imaging and Capsule Endoscopy: New Perspectives for a Whole Picture of the Small Bowel. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:28-35. [PMID: 28868427 PMCID: PMC5580122 DOI: 10.1016/j.jpge.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/09/2015] [Indexed: 11/22/2022]
Abstract
Small bowel evaluation is a challenging task and has been revolutionized by high-quality contrasted sectional imaging (CT enterography - CTE) and magnetic resonance enterography (MRE) as well as by small bowel capsule endoscopy (SBCE). The decision of which technique to employ during the investigation of small bowel diseases is not always simple or straightforward. Moreover, contraindications may preclude the use of these techniques in some patients, and although they are noninvasive procedures, may present with various complications. SBCE plays a crucial role in the investigation of both obscure gastrointestinal bleeding and Crohn's disease, but it is also useful for surveillance of patients with Peutz-Jeghers syndrome, while CTE is very accurate in small bowel tumours and in established Crohn's Disease, and its use in patients presenting with gastrointestinal bleeding is increasing. MRE, an expensive and not widely available technique, is essential for the study of patients with Crohn's Disease, and presents an attractive alternative to SBCE in Peutz-Jeghers syndrome surveillance. These diagnostic modalities are often not competitive but synergistic techniques. Knowing their characteristics, strengths and limitations, indications, contraindications and potential complications, as well as the adaptation to local availability and expertise, is essential to better select which procedures to perform in each patient, both safely and effectively, in order to optimize management and improve patient outcomes.
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Affiliation(s)
- Pedro Boal Carvalho
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - José Cotter
- Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's, PT Government Associate Laboratory, Guimarães, Portugal
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Unexpected Findings in Magnetic Resonance Enterography and Their Clinical Significance. Can J Gastroenterol Hepatol 2016; 2016:4020569. [PMID: 27446837 PMCID: PMC4904694 DOI: 10.1155/2016/4020569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 12/01/2015] [Indexed: 12/25/2022] Open
Abstract
Aims. To identify the prevalence of colonic and extraenteric incidental findings in magnetic resonance enterography (MRE) and their clinical significance. Methods. We retrospectively analysed 470 MRE studies carried out between March 2012 and 2014. Incidental findings were defined as those not expected from or made apparent on the referral. MRE reports were reviewed for colonic and extraenteric findings, subcategorised into "clinically significant" and "insignificant." Follow-up was identified from the electronic patient record. Results. The majority of MRE requests were made for inflammatory bowel disease (97%). In total, 114 incidental findings were noted in 94 (20%) scans performed. There were 29 "colonic" findings (25%) with 55% having a diagnosis of colitis. Out of 85 extraenteric findings, ovarian cysts (25%), renal cysts (10%), and abdominal lymphadenopathy (9%) were the commonest. Cumulatively, 59 cases were clinically significant (52%); of these, 30 findings were not previously diagnosed, amounting to 26% of all incidental findings. This led to intervention in seven patients. Conclusions. Incidental findings are common in MRE and there is a substantial proportion that is clinically significant and requires further investigation. There need to be stratification of risk and employment of local guidelines in order to achieve this.
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Coimbra AJF, Rimola J, O'Byrne S, Lu TT, Bengtsson T, de Crespigny A, Luca D, Rutgeerts P, Bruining DH, Fidler JL, Sandborn WJ, Santillan CS, Higgins PDR, Al-Hawary MM, Vermeire S, Vanbeckevoort D, Vanslembrouck R, Peyrin-Biroulet L, Laurent V, Herrmann KA, Panes J. Magnetic resonance enterography is feasible and reliable in multicenter clinical trials in patients with Crohn's disease, and may help select subjects with active inflammation. Aliment Pharmacol Ther 2016; 43:61-72. [PMID: 26548868 DOI: 10.1111/apt.13453] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 07/23/2015] [Accepted: 10/09/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Reliable tools for patient selection are critical for clinical drug trials. AIM To evaluate a consensus-based, standardised magnetic resonance enterography (MRE) protocol for selecting patients for inclusion in Crohn's disease (CD) multicenter clinical trials. METHODS This study recruited 20 patients [Crohn's Disease Activity Index (CDAI) scores: <150 (n = 8); 150-220 (n = 4); 220-450 (n = 8)], to undergo ileocolonoscopy and two MREs (with and without colonic contrast) within a 14-day period. Procedures were scored centrally using, Magnetic Resonance Index of Activity (MaRIA), and both Crohn's Disease Endoscopic Index of Severity (CDEIS) and Simplified Endoscopic Score (SES-CD). RESULTS 37 MREs were acquired. Both MREs were evaluable in 16 patients for calculation of test-retest and inter-reader reliability scores. The MaRIA scores for the terminal ileum had excellent test-retest and inter-reader reliability, with correlations >0.9. The proximal ileum showed strong within-reader agreement (0.90-0.96), and fair between-reader agreement (0.59-0.72). MRE procedures were tolerable. MaRIA scores correlated with CDEIS and SES-CD (0.63 and 0.71), but not with CDAI (0.34). MRE identified 3 patients with intra-abdominal complications, who would otherwise have been included in clinical trials. Furthermore, both MRE and ileocolonoscopy identified active bowel wall inflammation in 2 patients with CDAI <150, and none in 1 patient with CDAI > 220. Data quality was good/excellent in 85% of scans, and fair or better in 96%. CONCLUSIONS Magnetic resonance enterography of high-quality and reproducibility was feasible in a global multi- centre setting, with evidence for improved selectivity over CDAI and ileocolonoscopy in identifying appropriate CD patients for inclusion in therapeutic intervention trials.
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Affiliation(s)
| | - J Rimola
- Hospital Clínic de Barcelona, Catalonia, Spain
| | - S O'Byrne
- Genentech, Inc., South San Francisco, CA, USA
| | - T T Lu
- Genentech, Inc., South San Francisco, CA, USA
| | - T Bengtsson
- Genentech, Inc., South San Francisco, CA, USA
| | | | - D Luca
- Genentech, Inc., South San Francisco, CA, USA
| | - P Rutgeerts
- University Hospitals Leuven, Leuven, Belgium
| | | | | | - W J Sandborn
- University of California San Diego, La Jolla, CA, USA
| | - C S Santillan
- University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | - L Peyrin-Biroulet
- University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - V Laurent
- Adults University, Nancy University, Vandoeuvre-lès-Nancy, France
| | - K A Herrmann
- University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | - J Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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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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Shih IL, Lee TC, Tu CH, Chang CC, Wang YF, Tseng YH, Chiu HM, Wu MS, Wang HP, Shih TTF, Liu KL. Intraobserver and interobserver agreement for identifying extraluminal manifestations of Crohn's disease with magnetic resonance enterography. ADVANCES IN DIGESTIVE MEDICINE 2015. [DOI: 10.1016/j.aidm.2015.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Magnetic resonance enterography findings as predictors of clinical outcome following antitumor necrosis factor treatment in small bowel Crohn's disease. Eur J Gastroenterol Hepatol 2015; 27:956-62. [PMID: 26049706 DOI: 10.1097/meg.0000000000000399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AIMS To determine whether specific magnetic resonance enterography (MRE) findings can predict outcome following commencement of antitumor necrosis factor (aTNF) in small bowel Crohn's disease (CD) PATIENTS AND METHODS: This was a single-centre retrospective study of patients with CD who commenced aTNF (infliximab or adalimumab) between 2007 and 2013. Patients who had an MRE within 6 months before commencing aTNF were included. The primary end-point was the need for CD-related surgery. The secondary end-points were time to surgery and time to treatment failure. The relationship between these end-points, clinical variables and specific MRE findings were studied. RESULTS Four hundred and eighteen patients commenced aTNF for CD during the study period. Seventy-five patients had an MRE within 6 months before commencing aTNF (30 infliximab; 45 adalimumab). The median time from MRE to commencing aTNF was 43 days (IQR 19.5-87 days). Eighteen of 75 (24%) had surgery during a median follow-up of 16.7 months (IQR 9.0-30.1 months). Patients with small bowel stenosis (SBS) on MRE were at a significantly higher risk of requiring surgery: 12/18 (66.7%) versus 6/57 (10.5%) (P<0.001). Time to surgery was significantly shorter in patients with SBS on MRE (P<0.001). In a multivariate analysis, SBS (P<0.0001, hazard ratio 26.45, 95% confidence interval 5.45-128.49) and presence of penetrating complications (P=0.003, hazard ratio 36.53, 95% confidence interval 3.40-393.19) were associated independently with time to surgery. CONCLUSION SBS and penetrating complications on MRE are associated independently with a need for early surgery and treatment failure in patients commencing aTNF.
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