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Computerized tomography-based predictive model for differentiation of Crohn’s disease from intestinal tuberculosis

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Intestinal tuberculosis (ITB) and Crohn’s disease (CD) have clinical, radiological, endoscopic, and histological resemblance. There is paucity of literature regarding differentiation of CD and ITB based on radiology using computed tomography (CT).

Aims

The present study was designed to compare CT features of ITB and CD and develop a predictive model to differentiate ITB and CD.

Methods

Patients with ITB and CD, who underwent CT enteroclysis/CT enterography/CT abdomen before starting treatment, were recruited. Specific findings were noted by a radiologist who was blinded to the diagnosis. A predictive model was developed based on the features which were significantly different in these diseases.

Results

Fifty-four patients with CD and 50 patients with ITB were compared. On univariate analysis, left colonic involvement, ileocecal involvement, long-segment involvement, comb sign, presence of skip lesions, involvement of ≥3 segments and ≥1-cm sized lymph nodes were significantly different between CD and ITB. On multivariate analysis, ileocecal involvement, long-segment involvement and the presence of lymph node ≥1 cm were statistically significant. Based upon the latter three variables, a risk score (with values ranging from 0 to 3) was generated, with scores 0 and 1 having specificity of 100 % and 87 %, respectively, and positive predictive values (PPV) of 100 % and 76 %, respectively, for ITB and scores 2 and 3 having specificity of 68 % and 90 %, respectively, and PPV of 63 % and 80 %, respectively, for CD.

Conclusions

A predictive model based on the presence of long-segment involvement, ileocecal involvement and lymph nodes sized ≥1 cm on CT could differentiate ITB and CD with good specificity and PPV.

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Conflict of interest

SK, RS, BN, VPM, AA, RD, SS, LK, and VA declare that they have no conflict of interest.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning Human and Animal Rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

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Authors and Affiliations

  1. Department of Gastroenterology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Saurabh Kedia, Venigalla Pratap Mouli, Rajan Dhingra, Saurabh Srivastava, Lalit Kurrey & Vineet Ahuja

  2. Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Raju Sharma

  3. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India

    Birinder Nagi

  4. Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA, USA

    Ashwin Aananthakrishnan

Authors
  1. Saurabh Kedia
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  2. Raju Sharma
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  3. Birinder Nagi
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  4. Venigalla Pratap Mouli
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  5. Ashwin Aananthakrishnan
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  6. Rajan Dhingra
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  7. Saurabh Srivastava
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  8. Lalit Kurrey
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  9. Vineet Ahuja
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Corresponding author

Correspondence to Vineet Ahuja.

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Supplementary Fig. 1

Outliers in cases of intestinal tuberculosis and Crohn’s disease A) Long-segment colonic involvement with comb sign in a patient with Intestinal tuberculosis (arrow) B) Isolated terminal ileal involvement with caecal sparing and mural stratification in a patient with intestinal tuberculosis (arrow) C) Contiguous short segment ileocaecal involvement in a patient with Crohn’s disease (arrow) (GIF 252 kb)

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Kedia, S., Sharma, R., Nagi, B. et al. Computerized tomography-based predictive model for differentiation of Crohn’s disease from intestinal tuberculosis. Indian J Gastroenterol 34, 135–143 (2015). https://doi.org/10.1007/s12664-015-0550-y

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  • DOI: https://doi.org/10.1007/s12664-015-0550-y

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