Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohnʼs disease

Adler, Jeremy; Punglia, Darashana; Dillman, Jonathan R.; Polydorides, Alexandros; Dave, Maneesh; Al-Hawary, Mahmoud M.; Platt, Joel F.; McKenna, Barbara J.; Zimmermann, Ellen M.

doi:10.1002/ibd.21801

Cited by 174 publications

(130 citation statements)

References 30 publications

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“…Strictures in Crohn's disease can be inflammatory, fibrotic, or (most commonly) a combination of both. Ongoing efforts aim to validate approaches to addressing the relative contributions of active inflammation and fibrosis in Crohn's strictures, which is not possible at CT enterography [40]. If we can accurately make this distinction, gastroenterologists can more effectively triage patients to potent medical therapy vs. surgical intervention and avoid the morbidity inherent in misclassification in either direction (Fig.…”

Section: Mre Findings Used For Diagnosing Crohn's Diseasementioning

confidence: 99%

MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel

2015

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Section: Mre Findings Used For Diagnosing Crohn's Diseasementioning

confidence: 99%

MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel

2015

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“…Recent investigations have shown that contrast-enhanced US with microbubble contrast agents can be used to objectively assess disease activity in adults with small bowel Crohn disease (17,18). rowing have an active inflammatory component (Fig 9), although underlying fibrosis can also be present (19). Strictures without increased blood flow at Doppler US are commonly fibrotic and are less likely to respond to medical therapy.…”

Section: Hyperemiamentioning

confidence: 99%

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

Dillman¹,

Smith

Sanchez³

et al. 2015

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Small bowel Crohn disease is commonly diagnosed during the pediatric period, and recent investigations show that its incidence is increasing in this age group. Diagnosis and follow-up of this condition are commonly based on a combination of patient history and physical examination, disease activity surveys, laboratory assessment, and endoscopy with biopsy, but imaging also plays a central role. Ultrasonography (US) is an underutilized well-tolerated imaging modality for screening and follow-up of small bowel Crohn disease in children and adolescents. US has numerous advantages over computed tomographic (CT) enterography and magnetic resonance (MR) enterography, including low cost and no required use of oral or intravenous contrast material. US also has the potential to provide images with higher spatial resolution than those obtained at CT enterography and MR enterography, allows faster examination than does MR enterography, does not involve ionizing radiation, and does not require sedation or general anesthesia. US accurately depicts small bowel and mesenteric changes related to pediatric Crohn disease, and US findings show a high correlation with MR imaging findings in this patient population.

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“…These signs of active inflammation are clinically relevant because they usually indicate the potential for response to medical therapy, which can relieve the obstruction by reducing the inflammation [30]. Diagnosing a fibrotic stricture is more challenging as the absence of imaging signs of active inflammation is not diagnostic of fibrosis [31].…”

Section: Single Transition Zonementioning

confidence: 99%

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

et al. 2015

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Small bowel obstruction (SBO) accounts for a considerable proportion of emergency room visits, inpatient admissions, and surgical interventions in the United States. Multi-detector computed tomography (MDCT) plays a key role in imaging patients presenting with acute symptoms suggestive of SBO, which helps in establishing the diagnosis, elucidating the cause of obstruction, and detecting complications, such as ischemia or frank bowel necrosis and perforation. Recently, management of patients with SBO has shifted toward a more conservative approach with supportive care and nasogastric tube decompression, as the obstruction in many cases can resolve spontaneously without the need for operative intervention. However, management decisions in SBO remain notoriously difficult, relying on a combination of clinical, laboratory, and imaging factors to help stratify patients into conservative or surgical treatment. Imaging is often an important factor assisting in the decision-making process since traditional clinical signs of vascular compromise, such as acidosis, fever, leukocytosis, and tachycardia are often unreliable in predicting the need for operative intervention. Thus, it is critically important for radiologists to identify imaging features that suggest or indicated high likelihood of bowel vascular compromise in order to help optimize management prior to the development of bowel ischemia and eventually necrosis. By excluding signs of potentially ischemic or necrotic bowel on MDCT, patients may be spared unnecessary surgery, thus decreasing postsurgical complications and averting potential increase for the risk of future SBO and repeated surgery. Conversely, if imaging features indicate potential vascular compromise of the bowel wall that may lead to bowel ischemia, urgent surgical intervention may prevent progression to bowel necrosis and subsequent perforation.

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Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohnʼs disease

Cited by 174 publications

References 30 publications

MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel

MR enterography in Crohn’s disease: current consensus on optimal imaging technique and future advances from the SAR Crohn’s disease-focused panel

Pediatric Small Bowel Crohn Disease: Correlation of US and MR Enterography

MDCT findings in small bowel obstruction: implications of the cause and presence of complications on treatment decisions

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