Abstract
A new era of Crohn’s disease management exists where decisions are made by objective data as a necessary adjunct to patient symptoms. Cross-sectional imaging, particularly CT enterography (CTE) and MR enterography (MRE), provides powerful objective insights into the disease process resulting in a firm place for cross-sectional imaging in our current diagnostic and management paradigms. The high sensitivity and specificity of the techniques for the presence of bowel inflammation have helped pinpoint the location and severity of disease enabling diagnosis and facilitating assessment of symptoms. The ability to identify disease complications has helped direct medical therapy and enables more robust presurgical assessment. Emerging data suggest that cross-sectional imaging findings are sensitive to changes in inflammation resulting from our potent biologic therapies and may be used in amazing new ways such as in predicting disease course. Technological advances in CT and MR enterography have provided new insights into the disease processes while enhancing patient safety and tolerability. The goal of this chapter is to provide a gastroenterologist’s view of how cross-sectional imaging fits our current and future management algorithm. These remarkable technologies enable gastroenterologists and radiologists, working together, to serve our patient population in profound ways.
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References
Ananthakrishan AN, Xavier RJ, Podolsky DK. Inflammatory bowel disease: pathogenesis. In: Podolsky DK, et al., editors. Yamada’s textbook of gastroenterology. 6th ed. New York: Wiley; 2016. p. 1364–77.
Torres J, Mehandru S, Colombel JF, Peyrin-Biroulet L. Crohn’s disease. Lancet. 2017;389:1741–55.
Cosnes J, Gower-Rousseau C, Seksik P, Cortot A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology. 2011;140:1785–94.
Latella R, Sferra R, Speca S, Vetuschi A, Gaudio E. Can we prevent, reduce or reverse intestinal fibrosis in IBD? Eur Rev Med Pharmacol Sci. 2013;17:1283–304.
Khor B, Gardet A, Xavier RJ. Genetics and pathogenesis of inflammatory bowel disease. Nature. 2011;474:307–17.
Li Q, Lee CH, Peters LA, Mastropaolo LA, Thoeni C, Elkadri A, Schwerd T, Zhu J, Zhang B, Zhao Y, Hao K, Dinarzo A, Hoffman G, Kidd BA, Murchie R, Al Adham Z, Guo C, Kotlarz D, Cutz E, Walters TD, Shouval DS, Curran M, Dobrin R, Brodmerkel C, Snapper SB, Klein C, Brumell JH, Hu M, Nanan R, Snanter-Nanan B, Wong M, Le Deist F, Haddad E, Roifman CM, Deslandres C, Griffiths AM, Gaskin KJ, Uhlig HH, Schadt EE, Muise AM. Variants in TRIM22 that affect NOD2 Signaling are associated with very-early-onset inflammatory bowel disease. Gastroenterology. 2016;150:1196–207.
Al Nabhani Z, Dietrich G, Hugot JP, Barreau F. Nod2: the intestinal gate keeper. PLoS Pathog. 2017;13:e1006177. https://doi.org/10.1371/journal.ppat.1006177.
de Souza HSP, Fiocchi C, Iliopoulos D. The IBD interactome: an integrated view of aetiology, pathogenesis and therapy. Nat Rev Gastroenterol Hepatol. 2017;14:739–49.
Isene R, Bernklev T, Høie O, Munkholm P, Tsianos E, Stockbrügger R, Odes S, Palm O, Småstuen M, Moum B, The Ec-Ibd Study Group. Extraintestinal manifestations in Crohn’s disease and ulcerative colitis: results from a prospective, population-based European inception cohort. Scand J Gastroenterol. 2015;50:300–5.
Ministro P, Martins D. Fecal biomarkers in inflammatory bowel disease: how, when and why? Expert Rev Gastroenterol Hepatol. 2017;11:317–28.
Bruining DH, Bhatnagar G, Rimola J, Taylor S, Zimmermann EM, Fletcher JG. CT and MR imaging in Crohn’s disease: current and future applications. Abdom Imaging. 2015;40:965–74.
Colombel JF, Narula N, Peyrin-Biroulet L. Management strategies to improve outcomes of patients with inflammatory bowel diseases. Gastroenterology. 2017;152:351–61.
Enns RA, Hookey L, Armstrong D, Bernstein CN, Heitman SJ, Teshima C, Leontiadis GI, Tse F, Sadowski D. Clinical practice guidelines for the use of video capsule endoscopy. Gastroenterology. 2017;152:497–514.
Kopylov U, Ben-Horin S, Seidman EG, Eliakim R. Video capsule endoscopy of the small bowel for monitoring of Crohn's disease. Inflamm Bowel Dis. 2015;21:2726–35.
Quaia E, Gennari AG, Cova MA, van Beek EJR. Differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn's disease based on visual analysis: feasibility study combining conventional B-mode ultrasound, contrast-enhanced ultrasound and strain elastography. Ultrasound Med Biol. 2018;44:762–70.
Peyrin-Biroulet L, Harmsen WS, Tremaine WJ, et al. Surgery in a population-based cohort of Crohn’s disease from Olmsted County, Minnesota (1970–2004). Am J Gastroenterol. 2012;107:1693–701.
Bosch OG, Ordâs I, Rodriguez S, et al. Comparison of the impact of MRI and colonoscopy on management of Crohn’s disease. Gastroenterology. 2012;142:S-21–2.
Pariente B, Mary JY, Danese S, et al. Development of the Lémann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology. 2015;148:52–63.
Schreyer AG, Hoffstetter P, Daneschnejad M, Jung EM, Pawlik M, Friedrich C, Fellner C, Strauch U, Klebl F, Herfarth H, Zorger N. Comparison of conventional abdominal CT with MR-enterography in patients with active Crohn’s disease and acute abdominal pain. Acad Radiol. 2010;17:352–7.
Rimola J, Planell N, Rodríguez S, Delgado S, Ordás I, Ramírez-Morros A, et al. Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol. 2015;110:432–40.
Adler J, Punglia D, Dillman JR, Polydorides AD, Dave M, Al-Hawary MM, Platt JF, McKenna GJ, Zimmermann EM. CT enterography findings correlate with tissue inflammation in resected small bowel Crohn’s disease. Inflamm Bowel Dis. 2012;18:849–56.
Wagner M, Ko HM, Chatterji M, Besa C, Torres J, Zhang X, Panchal H, Hectors S, Cho J, Colombel JF, Harpaz N, Taouli B. Magnetic resonance imaging predicts histopathologic composition of ileal Crohn’s disease. J Crohns Colitis. 2018;12(6):718–29.
Bruining DH, Zimmermann EM, Loftus EV, Sanborn WJ, Sauer CG, Strong SA. Consensus guidelines for evaluation, interpretation and utilization of CT and MR enterography in small bowel Crohn’s disease patients. Radiology. 2018;286(3):776–99.
Flint A, Chaudhry NA, Riverso M, Pham, A, Moser PP, Mramba LK, Zimmermann EM, Grajo JR. Effective communication of cross-sectional imaging findings in Crohn’s disease: comparing conventional EMR reporting to a published scoring system. Abdom Radiol. 2017. https://doi.org/10.1007/s00261-017-1368-0.
Chaudhry NA, Riverso M, Grajo JR, Moser PP, Zou F, Homsi M, Punglia DR, Zimmermann EM. A fixed stricture on routine cross sectional imaging predicts disease-related complications and adverse outcomes in patients with Crohn’s disease. Inflamm Bowel Dis. 2017;23:641–9.
Castiglione F, Mainenti P, Testa A, Imperatore N, De Palma GD, Maurea S, Rea M, Nardone OM, Sanges M, Caporaso N, Rispo A. Cross-sectional evaluation of transmural healing in patients with Crohn’s disease on maintenance treatment with anti-TNF alpha agents. Dig Liver Dis. 2017;49:484–9.
Fiorino G, Peyrin-Biroulet L, Bonifacio C, et al. MRE and colonoscopy findings in early Crohn’s disease predict the course of the disease: a prospective observational cohort study. Gastroenterology. 2013;144:S-639.
Bickelhaupt S, Pazahr S, Chuck N, Blume I, Froehlich JM, Cattin R, Raible S, Bouquet H, Bill U, Rogler G, Frei P, Boss A, Patak MA. Crohn’s disease: small bowel motility impairment correlates with inflammatory-related markers C-reactive protein and calprotectin. Neurogastroenterol Motil. 2013;25:467–73.
Li XH, Mao R, Huang SY, Sun CH, Cao QH, Fang ZN, Zhang ZW, Huang L, Lin JJ, Chen YJ, Rimola J, Rieder F, Chen MH, Feng ST, Li ZP. Characterization of degree of intestinal fibrosis in patients with Crohn disease by using magnetization transfer MR imaging. Radiology. 2018;287:494–503.
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Zimmermann, E.M. (2019). The Clinical Impact of Cross-Sectional Imaging on Crohn’s Disease Management. In: Rimola, J. (eds) Cross-Sectional Imaging in Crohn’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-96586-4_1
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DOI: https://doi.org/10.1007/978-3-319-96586-4_1
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