Combination of increased visceral fat and long segment involvement: Development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis

Kedia, Saurabh; Madhusudhan, Kumble Seetharama; Sharma, Raju; Bopanna, Sawan; Yadav, Dhananjay; Goyal, Sandeep; Jain, Saransh; Das, Prasenjit; Dattagupta, S; Makharia, Govind; Ahuja, Vineet

doi:10.1111/jgh.14065

Cited by 19 publications

(20 citation statements)

References 30 publications

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“…This was validated in a separate validation cohort, with similar diagnostic accuracy. We further combined the CT features and VF/SC ratio to develop an updated model and showed that necrotic lymph nodes, long segment involvement, and VF/SC ratio > 0.63 were most significantly different between CD and ITB, both in the development and validation cohort[61]. Like the previous meta-analysis, presence of necrotic lymph node was exclusive for ITB, and so was not included in the model.…”

Section: Radiologymentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

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Differentiating Crohn’s disease (CD) and intestinal tuberculosis (ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical (diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic (longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic (caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic (positive stain/culture for acid fast-bacillus in ITB), radiologic (long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus (AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However, these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy (ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.

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Section: Radiologymentioning

confidence: 99%

Differentiating Crohn’s disease from intestinal tuberculosis

Kedia

Das

Madhusudhan

et al. 2019

WJG

Self Cite

143

109

View full text Add to dashboard Cite

show abstract

“…For imaging characteristics, especially CTE/MRE, patients with CD were more likely to show comb sign, target sign, adipose creeping sign and ≥4 segments involved. Kedia et al showed that comb sign was more common in CD [17], and no studies had compared target sign or adipose creeping sign in ITB and CD, but some studies have used them to build the differential models [8,18]. In our study, these three factors were probably easy to get influenced by other factors, and they failed to be selected as potential parameters in CART.…”

Section: Discussionmentioning

confidence: 77%

Development and Validation of a New Algorithm Model for Differential Diagnosis Between Crohn's Disease and Intestinal Tuberculosis: A Combination of Laboratory, Imaging and Endoscopic Characteristics

Lü

Chen

Peng

et al. 2021

Preprint

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Background: Sometimes in clinical practice, it was a great challenge to distinguish Crohn's disease (CD) and intestinal tuberculosis (ITB), we conducted this study was to identify simple and useful algorithm for distinguishing them.Methods: We retrospectively reviewed the medical history of the patients who were diagnosed as ITB or CD. We firstly identified ITB patients, and then the patients diagnosed with CD were matched by age, sex, and admission time in a 1:1 ratio. Patients who admitted between May 1, 2013 and April 30, 2019 were regarded as training cohort, and patients admitted between May 1, 2019 and May 1, 2020 were regarded as validation cohort. We used multivariate analysis to identify the potential variables, and then we used R package rpart to build the classification and regression tree (CART), and validated the newly developed model.Results: In total, the training cohort included 84 ITB and 84 CD patients, the validation cohort included 22 ITB and 22 CD patients. Multivariate analysis showed that, positive T-SPOT, ≥4 segments involved, longitudinal ulcer, circular ulcer, and aphthous ulcer were confirmed as independent discriminating factors. Using these parameters to build the CART model made an overall accuracy rate was 88.64%, with sensitivity, specificity, NPV, and PPV being 90.91%, 86.36%, 90.48% and 86.96%, respectively.Conclusion: We developed a simple and novel algorithm model covering laboratory, imaging, and endoscopy parameters with CART to differentiate ITB and CD with good accuracy.

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“…The models integrating clinical, endoscopy, pathology, and CTE are summarized in Table 2. 18,[24][25][26]28…”

Section: Models Integrating Clinical Endoscopy Pathology and Ctementioning

confidence: 99%

“…All models were reported to have an AUROC value greater than 0.85. However, only the models by Makharia et al, 6 Jung et al, 17 Mao et al, 18 Kedia et al, 28 Bae et al, 35 Wu et al, 36 He et al, 37 and Limsrivilai et al 38 were tested in validation cohorts in their original studies. Among those models, the models by Makharia et al, 6 Mao et al, 18 Bae et al, 35 Wu et al, 36 and He et al 37 were developed and validated based on prospective data.…”

Section: Model With Adjustable Integrated Variablesmentioning

confidence: 99%

Intestinal tuberculosis or Crohn’s disease: a review of the diagnostic models designed to differentiate between these two gastrointestinal diseases

Limsrivilai

Pausawasdi

2021

Intest Res

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diagnostic uncertainty due to the possible onset of potentially fatal complications if immunosuppressive agents are inappropriately prescribed to ITB patients. 9 However, 8-12 weeks of empiric ATT can delay appropriate CD treatment, and this can lead to exacerbation of disease and disease-related complications. 10 Additionally, ATT can cause many side effects, and may facilitate the development of Mycobacterium tuberculosis drug resistance. As a consequence of the difficulty distinguishing between these two conditions, many studies have been conducted that aimed to identify factors that could improve our ability to reliably diagnose these two GI diseases. Those studies did identify some significant characteristics, but none of those characteristics are exclusive to either ITB or CD. Alternatively, those research teams integrated the factors that they identified with established and more recently developed diagnostic parameters to create diagnostic models that could increase the accuracy of diagnosis. However, the number and

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Combination of increased visceral fat and long segment involvement: Development and validation of an updated imaging marker for differentiating Crohn's disease from intestinal tuberculosis

Abstract: Necrotic lymph nodes are exclusive for ITB, and the combination of long segment involvement and VF/SC ratio > 0.63 is exclusive for CD, and these features can make a definite diagnosis in 43% patients with a CD/ITB dilemma.

Cited by 19 publications

References 30 publications

Differentiating Crohn’s disease from intestinal tuberculosis

Differentiating Crohn’s disease from intestinal tuberculosis

Development and Validation of a New Algorithm Model for Differential Diagnosis Between Crohn's Disease and Intestinal Tuberculosis: A Combination of Laboratory, Imaging and Endoscopic Characteristics

Intestinal tuberculosis or Crohn’s disease: a review of the diagnostic models designed to differentiate between these two gastrointestinal diseases

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