Abstract
Purpose
Few studies have correlated computed tomography enterography (CTE) findings with Crohn’s disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity.
Materials and methods
The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn’s Disease Activity Index (CDAI) and some biochemical markers (C-reactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression.
Results
CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03).
Conclusion
The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.
Similar content being viewed by others
References
Biancone L, De Nigris F, Del Vecchio Blanco G et al (2002) Monitoring the activity of Crohn’s disease. Aliment Pharmacol Ther 16:29–33
Sandborn WJ, Feagan BG, Hanauer S et al (2002) A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology 122:512–530
Sostegni R, Daperno M, Scaglione N et al (2003) Review article: Crohn’s disease: monitoring disease activity. Aliment Pharmacol Ther 17:11–17
Colombel JF, Solem CA, Sandborn WJ et al (2006) Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: correlation with endoscopic severity and C reactive protein. Gut 55:1561–1567
Choi D, Jin Lee S, Ah Cho Y et al (2003) Bowel wall thickening in patients with Crohn’s disease: CT patterns and correlation with inflammatory activity. Clin Radiol 58:68–74
Del Campo L, Arribas I, Valbuena M et al (2001) Spiral CT findings in active and remission phases in patients with Crohn disease. J Comput Assist Tomogr 25:792–797
Gourtsoyiannis N, Papanikolaou N, Grammatikakis J et al (2004) Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: preliminary results. Eur Radiol 14:1017–1024
Minordi LM, Vecchioli A, Guidi L et al (2009) CT findings and clinical activity in Crohn’s disease. Clin Imaging 33:123–129
Desmond AN, O’Regan K, Malik N et al (2012) Selection of symptomatic patients with Crohn’s disease for abdominopelvic computed tomography: role of serum C-reactive protein. Clin Gastroenterol Hepatol 10:886–892
Bodily KD, Fletcher JG, Solem C et al (2006) Crohn disease: mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation. Radiology 238:505–516
Booya F, Fletcher JG, Huprich JE et al (2006) Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology 241:787–795
Meyers MA, McGuire PV (1995) Spiral CT demonstration of hypervascularity in Crohn disease: "vascular jejunization of the ileum" or the "comb sign". Abdom Imaging 20:327–332
Al-Hawary MM, Kaza RK, Platt JF (2013) CT enterography: concepts and advances in Crohn’s disease imaging. Radiol Clin N Am 51:1–16
Higgins PD, Caoili E, Zimmermann M et al (2007) Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis 13:262–268
Lee SS, Kim AY, Yang SK et al (2009) Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 251:751–761
Kroeker KI, Lam S, Birchall I, Fedorak RN (2011) Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol 45(1):34–39
Hanauer SB, Sandborn WJ (2007) European evidence-based consensus on the diagnosis and management of Crohn’s disease. Gut 56:161–163
Lo Re G, Galia M, Bartolotta TV et al (2007) Forty-slice TCMD enteroclysis: evaluation after oral administration of isotonic solution in Crohn’s disease. Radiol Med 112:787–797
McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26:503–512
Huda W, Mettler FA (2011) Volume CT dose index and dose–length product displayed during CT: what good are they? Radiology 258:236–242
Al-Hawary MM, Zimmermann EM (2010) Choosing the right cross-sectional imaging technique: trading image quality for radiation risk. Inflamm Bowel Dis 17:1089–1091
Horsthuis K, Bipat S, Bennink RJ (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: metaanalysis of prospective studies. Radiology 247:64–79
Goldberg HI, Gore RM, Margulis AR et al (1983) Computed tomography in the evaluation of Crohn disease. AJR Am J Roentgenol 140:277–282
Madureira AJ (2004) The comb sign. Radiology 230:783–784
Lucey BC, Stuhlfaut JW, Soto JA (2005) Mesenteric lymph nodes: detection and significance on MDCT. Radiographics 25:351–365
Silverberg MS, Satsangi J, Ahmad T et al (2005) Toward and integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol 19:5–36
Fishman EK, Wolf EJ, Jones B et al (1987) CT evaluation of Crohn’s disease: effect on patient management. AJR Am J Roentgenol 148:537–540
Van Assche G (2009) Mucosal healing as a treatment goal in Crohn’s disease. J Gastroenterol Hepatol (NY) 5:558–559
Hara AK, Alam S, Heigh RI et al (2008) Using CT enterography to monitor Crohn’s disease activity: a preliminary study. AJR Am J Roentgenol 190:1512–1516
Pariente B, Peyrin-Biroulet L, Cohen L et al (2011) Gastroenterology review and perspective: the role of cross-sectional imaging in evaluating bowel damage in Crohn disease. AJR Am J Roentgenol 197:42–49
Van Assche G, Dignass A, Panes J et al (2010) The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis. J Crohns Colitis 4:7–27
Desreumaux P, Ernst O, Geboes K et al (1999) Inflammatory alterations in mesenteric adipose tissue in Crohn’s disease. Gastroenterology 117:73–81
Maccioni F, Viscido A, Broglia L et al (2000) Evaluation of Crohn disease activity with magnetic resonance imaging. Abdom Imaging 25:219–228
Neurath MF, Vehling D, Schunk K et al (2002) Noninvasive assessment of Crohn’s disease activity: a comparison of 18F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies. Am J Gastroenterol 97:1978–1985
Schunk K, Kern A, Oberholzer K et al (2000) Hydro-MRI in Crohn’s disease: appraisal of disease activity. Invest Radiol 35:431–437
Solem CA, Loftus EV Jr, Tremaine WJ et al (2005) Correlation of C-reactive protein with clinical, endoscopic, histologic and radiographic activity in inflammatory bowel disease. Inflamm Bowel Dis 11:707–712
Lee SS, Ha HK, Yang SK et al (2002) CT of prominent pericolic or perienteric vasculature in patients with Crohn’s disease: correlation with clinical disease activity and findings on barium studies. AJR Am J Roentgenol 179:1029–1036
Brignola C, Campieri M, Bazzocchi G et al (1986) A laboratory index for predicting relapse in asymptomatic patients with Crohn’s disease. Gastroenterology 91:1490–1494
Hatoum OA, Binion DG (2005) The vasculature and inflammatory bowel disease: contribution to pathogenesis and clinical pathology. Inflamm Bowel Dis 11:304–313
Hatoum OA, Binion DG, Otterson MF et al (2003) Acquired microvascular dysfunction in inflammatory bowel disease: loss of nitric oxide-mediated vasodilation. Gastroenterology 125:58–69
Conflict of interest
Giuseppe Lo Re, Maria Cappello, Chiara Tudisca, Massimo Galia, Claudia Randazzo, Antonio Craxì, Calogero Cammà, Andrea Giovagnoni, Massimo Midiri declare no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lo Re, G., Cappello, M., Tudisca, C. et al. CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants. Radiol med 119, 658–666 (2014). https://doi.org/10.1007/s11547-013-0377-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-013-0377-5