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Joel G Fletcher - One of the best experts on this subject based on the ideXlab platform.
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Computed Tomography and magnetic resonance small bowel Enterography current status and future trends focusing on crohn s disease
Gastroenterology Clinics of North America, 2018Co-Authors: Seong Ho Park, Tae Young Lee, Joel G FletcherAbstract:Computed Tomography Enterography (CTE) and magnetic resonance Enterography (MRE) are presently state-of-the-art radiologic tests used to examine the small bowel for various indications. This article focuses on CTE and MRE for the evaluation of Crohn disease. The article describes recent efforts to achieve more standardized interpretation of CTE and MRE, summarizes recent research studies investigating the role and impact of CTE and MRE more directly for several different clinical and research issues beyond general diagnostic accuracy, and provides an update on progress in imaging techniques. Also addressed are areas that need further exploration in the future.
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Computed Tomography Enterography
Radiologic Clinics of North America, 2018Co-Authors: Shannon P Sheedy, Joel G Fletcher, Amy B Kolbe, Jeff L FidlerAbstract:Computed Tomography (CT) Enterography is a noninvasive imaging modality with superb spatial and temporal resolution, specifically tailored to evaluate the small bowel. It has several advantages over other radiologic and optical imaging modalities, all of which serve as complementary investigations to one another. This article describes CTE technique, including dose reduction techniques, special considerations for the pediatric population, common technical and interpretive pitfalls, and reviews some of the more common small bowel entities seen with CTE.
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Computed Tomography Enterography and inflammatory bowel disease
2017Co-Authors: Joel G FletcherAbstract:CT Enterography is a high spatial and temporal resolution multidetector CT exam of the abdomen and pelvis, following the administration of a large volume of enteric contrast agent that distends the small bowel. It provides exquisite images of the small bowel wall, lumen, and perienteric tissues. It can be routinely performed in the outpatient setting in nearly all radiology departments to evaluate for inflammatory bowel disease and other small bowel diseases. Improvements in CT technology have enabled greater adaptation of CT technique to clinical questions and dramatically reduced radiation dose. Over the past decade, CT Enterography has become a widely available test with interpreted with local expertise, and there is emerging standardization of acquisition techniques and image interpretation methods, especially with relation to the staging of Crohn’s disease [1, 2]. CT Enterography is complementary to other imaging modalities, and provides unique information that impacts clinical management of patients with inflammatory bowel disease.
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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
Inflammatory Bowel Diseases, 2016Co-Authors: Parakkal Deepak, Jeff L Fidler, Joel G Fletcher, David H BruiningAbstract: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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endoscopic skipping of the distal terminal ileum in crohn s disease can lead to negative results from ileocolonoscopy
Clinical Gastroenterology and Hepatology, 2012Co-Authors: David H Bruining, Edward V Loftus, Jayawant N Mandrekar, Joel G Fletcher, Alan R Zinsmeister, Sunil Samuel, Brenda D Becker, William J SandbornAbstract:Background & Aims Crohn's disease often involves the terminal ileum (TI), but skipping of the distal TI can occur. This can lead to negative results from ileocolonoscopy. We analyzed advanced cross-sectional images to determine how frequently this occurs. Methods We analyzed data from 189 consecutive patients (55% women) with Crohn's disease, evaluated in 2009 by Computed Tomography Enterography (CTE) and ileocolonoscopy. The discharge impression of the gastroenterologist who treated the patients was used as the reference standard for Crohn's disease activity. Results Of the patients evaluated, 153 underwent TI intubation during endoscopy; 67 of these (43.8%) had normal results from ileoscopy, based on endoscopic appearance. Despite their normal results from ileoscopy, 36 of these patients (53.7%) had active, small-bowel Crohn's disease. The ileum appeared normal at ileoscopy because the disease had skipped the distal ileum of 11 patients (30.6%), developed only in the intramural and mesenteric distal ileum of 23 patients (63.9%), and appeared only in the upper gastrointestinal region of 2 patients (5.6%). These patients had a shorter duration of disease (61.1% for less than 5 years) compared with those found to have Crohn's disease based on ileoscopy (41.1% for less than 5 years; P Conclusions Ileoscopy examination can miss Crohn's disease of the TI because the disease can skip the distal ileum or is confined to the intramural portion of the bowel wall and the mesentery. CTE complements ileocolonoscopy in assessing disease activity in patients with Crohn's disease.
Jeff L Fidler - One of the best experts on this subject based on the ideXlab platform.
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Computed Tomography Enterography
Radiologic Clinics of North America, 2018Co-Authors: Shannon P Sheedy, Joel G Fletcher, Amy B Kolbe, Jeff L FidlerAbstract:Computed Tomography (CT) Enterography is a noninvasive imaging modality with superb spatial and temporal resolution, specifically tailored to evaluate the small bowel. It has several advantages over other radiologic and optical imaging modalities, all of which serve as complementary investigations to one another. This article describes CTE technique, including dose reduction techniques, special considerations for the pediatric population, common technical and interpretive pitfalls, and reviews some of the more common small bowel entities seen with CTE.
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small bowel imaging Computed Tomography Enterography magnetic resonance Enterography angiography and nuclear medicine
Gastrointestinal Endoscopy Clinics of North America, 2017Co-Authors: Jeff L Fidler, Ajit H Goenka, Chad J Fleming, James C AndrewsAbstract:Abstract Radiology examinations play a major role in the diagnosis, management, and surveillance of small bowel diseases and are complementary to endoscopic techniques. Computed Tomography Enterography and magnetic resonance Enterography are the cross-sectional imaging studies of choice for many small bowel diseases. Angiography still plays an important role for catheter-directed therapies. With the emergence of hybrid imaging techniques, radionuclide imaging has shown promise for the evaluation of small bowel bleeding and Crohn disease and may play a larger role in the future. This article reviews recent advances in technology, diagnosis, and therapeutic options for selected small bowel disorders.
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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
Inflammatory Bowel Diseases, 2016Co-Authors: Parakkal Deepak, Jeff L Fidler, Joel G Fletcher, David H BruiningAbstract: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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benefit of Computed Tomography Enterography in crohn s disease effects on patient management and physician level of confidence
Inflammatory Bowel Diseases, 2012Co-Authors: David H Bruining, Jeff L Fidler, Hassan Siddiki, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J Sandborn, Joel G Fletcher, Paul E Evans, William A FaubionAbstract:Background: Computed tomographic Enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms. (Inflamm Bowel Dis 2011;)
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Computed Tomography Enterography detects intestinal wall changes and effects of treatment in patients with crohn s disease
Clinical Gastroenterology and Hepatology, 2011Co-Authors: David H Bruining, Jeff L Fidler, Edward V Loftus, Eric C Ehman, Hassan Siddiki, Douglas L Nguyen, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J SandbornAbstract:Background & Aims The use of Computed Tomography Enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215–630). Results Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.
Minhu Chen - One of the best experts on this subject based on the ideXlab platform.
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evaluation of intestinal tuberculosis by multi slice Computed Tomography Enterography
BMC Infectious Diseases, 2015Co-Authors: Jing Zhao, Minyi Cui, Tao Chan, Ren Mao, Yanji Luo, Indira Barua, Minhu Chen, Shiting FengAbstract:Background Multi-slice Computed Tomography Enterography (MSCTE) is now widely used to diagnose and monitor intestinal disease. Preliminary studies suggest that MSCTE may be useful in detecting intestinal tuberculosis (ITB). We sought to assess the use of MSCTE for the diagnosis of ITB in our medical center.
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systematic review with meta analysis magnetic resonance Enterography vs Computed Tomography Enterography for evaluating disease activity in small bowel crohn s disease
Alimentary Pharmacology & Therapeutics, 2014Co-Authors: Yun Qiu, Ren Mao, Baili Chen, Zhirong Zeng, Minhu ChenAbstract:Summary Background Magnetic resonance Enterography (MRE) has been proposed as a non-ionising alternative method to Computed Tomography Enterography (CTE). Some studies have directly compared CTE and MRE in patients with small bowel Crohn's disease (CD) with variable results. Aim To compare the overall diagnostic accuracy in assessing the activity of small bowel and complications. Methods MEDLINE, EMBASE and Cochrane databases were searched for studies on the accuracy of MRE and CTE, as compared with a pre-defined reference standard. Pooled sensitivity, specificity, the weighted area under the curve (AUC), incremental yield (IY) and other diagnostic indices were evaluated. Results A total of 290 CD patients from six different studies were analysed. The pooled sensitivity and specificity for MRE in detecting active small bowel CD was 87.9% [95% confidence interval (CI), 81.8–92.5] and 81.2% (95% CI: 71.9–88.4) respectively. The AUC under the summary receiver-operating characteristic (sROC) of MRE was 0.905 (SEM 0.03, standard error of the mean). Likewise, the pooled sensitivity and specificity of CTE in detecting active small bowel CD was 85.8% (95% CI: 79.2–90.9) and 83.6% (95% CI: 75.3–90.1) with the AUC of 0.898. The AUC of MRE in detecting fistula, stenosis and abscess was 0.936, 0.931 and 0.996, respectively, compared to 0.963, 0.616 and 0.899 of CTE. No statistically significant IY for MRE vs. CTE was found (fixed model, P > 0.05). Conclusions Magnetic resonance Enterography has a diagnostic effectiveness comparable to Computed Tomography Enterography, thus may serve as a radiation-free alternative for evaluation of patients with Crohn's disease.
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su1294 Computed Tomography Enterography versus magnetic resonance Enterography for assessment of disease activity and complications in small bowel crohn s disease a meta analysis of head to head comparative studies
Gastroenterology, 2014Co-Authors: Yun Qiu, Ren Mao, Baili Chen, Zhirong Zeng, Minhu ChenAbstract:Introduction. Infliximab has led to new therapeutic goals in Crohn's disease (CD) such as complete mucosal healing and improvement of quality of life. The current standard for assessing mucosal healing is endoscopy. However, frequent assessments are costly and uncomfortable to the patient. Non-invasive, accurate surrogate serum markers would therefore be welcomed to aid clinicians in predicting mucosal healing.Methods. In a retrospective study, 119 CD patients who started infliximab and who underwent serial endoscopies (before and during infliximab) were included. Serum samples were available at the time of endoscopy and levels of markers were correlated with the degree of healing (not healed, marked improvement or complete healing). Thirty-five biomarkers were measured in 181 serum samples with the use of CEER, a proprietary highly sensitive protein micro-array, or homogenous mobility shift assays (Prometheus Laboratories Inc., San Diego, CA). These markers included growth and repair factors, pro -and anti-inflammatory markers and the IBD SGI serology panel. Infliximab and antibodies to infliximab were also measured. Clinical information regarding age at sampling, gender, age at diagnosis, location of disease, anal involvement and previous surgery was included. For statistical analysis SPSS and R were used. Results. From the 119 CD patients, 64 CD patients showed complete healing with no relapse, whereas 55 CD patients never showed mucosal healing. Univariate analyses indicated that age and 12 serum markers (HGF, BTC, TWEAK, CRP, ICAM, SAA, VCAM, IL-2, IL-8, IFN-γ, IL-6 and IL-10) were significantly associated with mucosal healing (p 11.44 CU/ml, TWEAK>20.62 CU/ml and VCAM<4200 μg/ml) which resulted in a significant and gradual increased prediction of mucosal healing (Figure 1, linear-by-linear p<0.001). Conclusion. We have identified 1 clinical parameter and 4 serum markers as independent predictors of mucosal healing. All serum markers play a role in the pathogenic mechanisms of CD. HGF has a central role in angiogenesis and tissue regeneration, BTC is a member of the EGF family of growth factors, TWEAK is a cytokine that has overlapping signaling functions with TNF and VCAM is a cell-adhesion molecule. The combined biomarker panel could facilitate prediction of mucosal healing in the future.
David H Bruining - One of the best experts on this subject based on the ideXlab platform.
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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
Inflammatory Bowel Diseases, 2016Co-Authors: Parakkal Deepak, Jeff L Fidler, Joel G Fletcher, David H BruiningAbstract: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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endoscopic skipping of the distal terminal ileum in crohn s disease can lead to negative results from ileocolonoscopy
Clinical Gastroenterology and Hepatology, 2012Co-Authors: David H Bruining, Edward V Loftus, Jayawant N Mandrekar, Joel G Fletcher, Alan R Zinsmeister, Sunil Samuel, Brenda D Becker, William J SandbornAbstract:Background & Aims Crohn's disease often involves the terminal ileum (TI), but skipping of the distal TI can occur. This can lead to negative results from ileocolonoscopy. We analyzed advanced cross-sectional images to determine how frequently this occurs. Methods We analyzed data from 189 consecutive patients (55% women) with Crohn's disease, evaluated in 2009 by Computed Tomography Enterography (CTE) and ileocolonoscopy. The discharge impression of the gastroenterologist who treated the patients was used as the reference standard for Crohn's disease activity. Results Of the patients evaluated, 153 underwent TI intubation during endoscopy; 67 of these (43.8%) had normal results from ileoscopy, based on endoscopic appearance. Despite their normal results from ileoscopy, 36 of these patients (53.7%) had active, small-bowel Crohn's disease. The ileum appeared normal at ileoscopy because the disease had skipped the distal ileum of 11 patients (30.6%), developed only in the intramural and mesenteric distal ileum of 23 patients (63.9%), and appeared only in the upper gastrointestinal region of 2 patients (5.6%). These patients had a shorter duration of disease (61.1% for less than 5 years) compared with those found to have Crohn's disease based on ileoscopy (41.1% for less than 5 years; P Conclusions Ileoscopy examination can miss Crohn's disease of the TI because the disease can skip the distal ileum or is confined to the intramural portion of the bowel wall and the mesentery. CTE complements ileocolonoscopy in assessing disease activity in patients with Crohn's disease.
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benefit of Computed Tomography Enterography in crohn s disease effects on patient management and physician level of confidence
Inflammatory Bowel Diseases, 2012Co-Authors: David H Bruining, Jeff L Fidler, Hassan Siddiki, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J Sandborn, Joel G Fletcher, Paul E Evans, William A FaubionAbstract:Background: Computed tomographic Enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms. (Inflamm Bowel Dis 2011;)
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Computed Tomography Enterography detects intestinal wall changes and effects of treatment in patients with crohn s disease
Clinical Gastroenterology and Hepatology, 2011Co-Authors: David H Bruining, Jeff L Fidler, Edward V Loftus, Eric C Ehman, Hassan Siddiki, Douglas L Nguyen, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J SandbornAbstract:Background & Aims The use of Computed Tomography Enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215–630). Results Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.
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Crohn’s disease clinical issues and treatment: what the radiologist needs to know and what the gastroenterologist wants to know
Abdominal Imaging, 2009Co-Authors: David H Bruining, Edward V LoftusAbstract:Crohn’s disease is an idiopathic chronic intestinal illness that requires specialized medical care for prompt disease diagnosis and appropriate management. Clinicians must accurately interpret and integrate findings from multitude of sources in order to achieve diagnostic certainty. Ileocolonoscopy remains the most relied modality, allowing for a direct mucosal visualization and biopsies for histologic assessments. Serologic markers currently serve an adjunctive role, often utilized in attempts to further subtype patients with indeterminate colitis. Radiologic imaging, such as Computed Tomography Enterography can evaluate the far reaches of the small intestine, while also providing information about penetrating complications and extraintestinal disease manifestations. Treatment options and strategies continue to evolve with new biologic agents and ongoing testing of aggressive “top–down” approaches. In addition, identification of increased colorectal cancer risks in individuals with Crohn’s colitis has led to formal surveillance guidelines. The clinical diagnosis and management of Crohn’s disease continues to be an area of rapid change and exciting developments.
William J Sandborn - One of the best experts on this subject based on the ideXlab platform.
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endoscopic skipping of the distal terminal ileum in crohn s disease can lead to negative results from ileocolonoscopy
Clinical Gastroenterology and Hepatology, 2012Co-Authors: David H Bruining, Edward V Loftus, Jayawant N Mandrekar, Joel G Fletcher, Alan R Zinsmeister, Sunil Samuel, Brenda D Becker, William J SandbornAbstract:Background & Aims Crohn's disease often involves the terminal ileum (TI), but skipping of the distal TI can occur. This can lead to negative results from ileocolonoscopy. We analyzed advanced cross-sectional images to determine how frequently this occurs. Methods We analyzed data from 189 consecutive patients (55% women) with Crohn's disease, evaluated in 2009 by Computed Tomography Enterography (CTE) and ileocolonoscopy. The discharge impression of the gastroenterologist who treated the patients was used as the reference standard for Crohn's disease activity. Results Of the patients evaluated, 153 underwent TI intubation during endoscopy; 67 of these (43.8%) had normal results from ileoscopy, based on endoscopic appearance. Despite their normal results from ileoscopy, 36 of these patients (53.7%) had active, small-bowel Crohn's disease. The ileum appeared normal at ileoscopy because the disease had skipped the distal ileum of 11 patients (30.6%), developed only in the intramural and mesenteric distal ileum of 23 patients (63.9%), and appeared only in the upper gastrointestinal region of 2 patients (5.6%). These patients had a shorter duration of disease (61.1% for less than 5 years) compared with those found to have Crohn's disease based on ileoscopy (41.1% for less than 5 years; P Conclusions Ileoscopy examination can miss Crohn's disease of the TI because the disease can skip the distal ileum or is confined to the intramural portion of the bowel wall and the mesentery. CTE complements ileocolonoscopy in assessing disease activity in patients with Crohn's disease.
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benefit of Computed Tomography Enterography in crohn s disease effects on patient management and physician level of confidence
Inflammatory Bowel Diseases, 2012Co-Authors: David H Bruining, Jeff L Fidler, Hassan Siddiki, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J Sandborn, Joel G Fletcher, Paul E Evans, William A FaubionAbstract:Background: Computed tomographic Enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care. Methods: We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale). Results: CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%). Conclusions: CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms. (Inflamm Bowel Dis 2011;)
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Computed Tomography Enterography detects intestinal wall changes and effects of treatment in patients with crohn s disease
Clinical Gastroenterology and Hepatology, 2011Co-Authors: David H Bruining, Jeff L Fidler, Edward V Loftus, Eric C Ehman, Hassan Siddiki, Douglas L Nguyen, James E Huprich, Jayawant N Mandrekar, William S Harmsen, William J SandbornAbstract:Background & Aims The use of Computed Tomography Enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215–630). Results Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.
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validation of a lower radiation Computed Tomography Enterography imaging protocol to detect crohn s disease in the small bowel
Inflammatory Bowel Diseases, 2011Co-Authors: Hassan Siddiki, Jeff L Fidler, James E Huprich, William J Sandborn, Joel G Fletcher, Amy K Hara, James M Kofler, Cynthia H Mccollough, Luis S Guimaraes, Edward V LoftusAbstract:Background: The purpose was to validate a lower radiation dose Computed Tomography Enterography (CTE) imaging protocol to detect the presence of Crohn's disease (CD) in the small bowel using two different reference standards and to identify a prediction model based on CTE signs for the presence of active CD. Methods: This retrospective study included patients with known or suspected CD who underwent CTE between January and October 2006 according to a lower radiation dose protocol. Two gastrointestinal radiologists blindly and independently classified each CTE as being active or inactive. Reference standards included ileocolonoscopy ± biopsy and a comprehensive clinical reference standard (retrospectively created by a gastroenterologist, also including history, physical, follow-up course, and subsequent endoscopy, imaging, or surgery). Logistic regression was used to identify CTE findings that predicted the presence of active CD based on the combined clinical reference standard. Results: In all, 137 patients underwent CTE and ileocolonoscopy. Using an endoscopic reference standard, the sensitivity of CTE to detect active CD for the two readers was 81% and 89%, respectively. Using the clinical reference standard, the sensitivity of CTE to detect active CD was 89% and 98%, respectively. For both readers the sensitivity of CTE increased by 8%–9% when using the comprehensive reference standard. Multivariate analysis showed that a combination of mural thickness and hyperenhancement best predicted active CD (area under the curve [AUC] = 0.92–0.93, P < 0.0001). Conclusions: Lower radiation dose CTE exams are sensitive for the detection of active small bowel CD. The combination of mural thickness and hyperenhancement are the best radiologic predictors of active CD. (Inflamm Bowel Dis 2011;)
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quantitative measurement and visual assessment of ileal crohn s disease activity by Computed Tomography Enterography correlation with endoscopic severity and c reactive protein
Gut, 2006Co-Authors: Jeanfrederic Colombel, Edward V Loftus, William S Harmsen, William J Sandborn, Craig A Solem, Fargol Booya, Alan R Zinsmeister, Kale D Bodily, Joel G FletcherAbstract:Background: Few studies have correlated Computed Tomography (CT) Enterography findings with endoscopic severity and C reactive protein (CRP) concentrations. Aim: To examine whether small bowel inflammation at CT Enterography correlates with endoscopic severity and CRP in patients with Crohn’s disease (CD). Methods: CT Enterography datasets from 143 CD patients undergoing ileoscopy were examined for three different CT parameters: CT bowel enhancement, as defined by the ratio of terminal ileal versus control ileal loop attenuation; vascular enlargement of the vasa recta (“the comb sign”); and mesenteric fat density. Correlations between CT scan parameters, endoscopy, and histology severity scores, and CRP were assessed using Spearman’s rank correlation and logistic regression. Results: Endoscopic score was significantly correlated with CT bowel enhancement, comb sign, and fat density (Spearman correlation coefficients 0.33–0.39; p r = 0.34–0.38; p v 0.23, p = 0.002). CRP did not differ significantly between patients without evidence of active Crohn’s and those with bowel enhancement and endoscopic inflammation not involving the perienteric tissues by CT (median 0.24 v 0.36; p = 0.38). Conclusion: Quantitative measures of bowel enhancement at CT Enterography correlate with endoscopic and histological severity. CRP correlates with radiological findings of perienteric inflammation (increased fat density), but not of inflammation limited to the small bowel wall, underscoring the potential role of perienteric inflammation in CRP response in CD.