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Diagnostic accuracy of CT enterography correlated to histopathology in the diagnosis of small bowel Crohnʼs disease

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Abstract

Background

Crohn’s disease (CD) is a chronic inflammatory process affecting the gastrointestinal tract, mainly the terminal ileum of small bowel. Although ileocolonoscopy provides good mucosal visualization, it does not allow evaluation of extraluminal abnormalities. Computed tomographic enterography (CTE) is an emerging imaging modality for assessment of small bowel disorders. The study aimed to explore the diagnostic accuracy of CTE in the diagnosis of patients with CD benchmarked against a histopathological reference.

Methods

A cross-sectional study entailed 126 consecutive patients with known or suspected CD who underwent CTE and biopsy by ileocolonoscopy via retrograde terminal ileum intubation. Spearman’s rank was used to test the correlation and Kappa coefficient agreement between CTE and histopathology. Area under the curve (AUC) of receiver operating characteristic (ROC) was used to measure CTE diagnostic accuracy.

Results

The overall sensitivity and specificity of CTE were 93.88% and 85.71%, respectively. The PPV was 95.83%, and the NPV was 80%. The accuracy of CTE indicated an overall probability of correct patient classification of 92.06%. The AUC of the ROC of CTE was 0.898 (P < 0.001). Thus, CTE has a high sensitivity for assessment of small bowel CD. The CTE and histopathological gradings were strongly correlated (Spearman’s coefficient = 0.962, P < 0.001). CTE exhibited perfect agreement with histopathology (Kappa coefficient (κ) = 0.847, P < 0.001).

Conclusion

CTE is a reliable technique that has high diagnostic accuracy in the assessment of CD. Hence, it may be useful for follow up and for preoperative guidance in treatment planning.

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Abbreviations

AUC:

Area under the curve

CTE:

Computed tomography enterography

CD:

Crohn’s Disease

MRE:

Magnetic resonance enterography

NPV:

Negative predictive value

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

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Acknowledgements

The authors wish to thank Prof. Thomas Foster of the University of Rochester, Rochester, NY USA for his careful reading of the manuscript, helpful suggestions, and English language editing.

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Authors and Affiliations

  1. Radiology Department, Al-Shifa Hospital, Gaza, Palestine

    Husam H. Mansour

  2. Medical Imaging Department, Al-Azhar University, Gaza, Palestine

    Husam H. Mansour, Yasser S. Alajerami, Khaled M. Abushab & Khetam M. Quffa

  3. Nursing Department, Al-Azhar University, Gaza, Palestine

    Ahmed A. Najim

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  1. Husam H. Mansour
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  2. Yasser S. Alajerami
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  3. Khaled M. Abushab
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Contributions

All the authors participated in the study conception and design, data gathering, data analysis and interpretation, manuscript drafting, and revising. All the contributors approved the manuscript and agreed to publish the study.

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Correspondence to Husam H. Mansour.

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This research involved human subjects and was performed in accordance with the Declaration of Helsinki with approval number PHRC/HC/567/19, Gaza strip-Palestine.

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Mansour, H.H., Alajerami, Y.S., Abushab, K.M. et al. Diagnostic accuracy of CT enterography correlated to histopathology in the diagnosis of small bowel Crohnʼs disease. Ir J Med Sci 191, 2605–2610 (2022). https://doi.org/10.1007/s11845-021-02917-4

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