Correlation of CT Enteroclysis With Surgical Pathology in Crohn's Disease

Chiorean, Michael; Sandrasegaran, Kumar; Saxena, Romil; Maglinte, Dean D. T.; Nakeeb, Attila; Johnson, Cynthia S.

doi:10.1111/j.1572-0241.2007.01537.x

Cited by 213 publications

(159 citation statements)

References 32 publications

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“…The regression of inflammatory activity of CD at the strictureplasty site has been well documented by radiological, ultrasonographic, endoscopic or histological investigations [27][28][29][30][31] . During a reoperation, the surgeon can ap-…”

Section: Discussionmentioning

confidence: 99%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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AIM:To investigate the status of the lymphatic vessels in the small bowel affected by Crohn's disease (CD) at the moment of surgery. METHODS:During the period January 2011-June 2011, 25 consecutive patients affected by CD were operated on in our Institution. During surgery, Patent Blue Ⅴ was injected subserosally and the way it spread along the subserosa of the intestinal wall, through the mesenterial layers towards the main lymphatic collectors and eventually to the lymph nodes was observed and recorded. Since some patients had been undergone strictureplasty at previous surgery, we also examined the status of intestinal lymph vessels after previous strictureplasties. The same procedure was performed in a control group of 5 patients affected by colorectal cancer. Length of lesions, caliber, maximal thickness of the diseased intestinal wall, thickness of the wall at injection site and thickness of the mesentery were evaluated at surgery. RESULTS:We observed three features after the injection of Patent Blue Ⅴ in the intestinal loops: (1) Macroscopically healthy terminal ileum of patients with CD or colon cancer showed thin lymphatic vessels linearly directed toward the mesentery; (2) In mild lesions in which the intestinal wall did not reach 8 mm of thickness, we observed short, wide and tortuous lymphatic vessels directed longitudinally along the intestinal axis toward disease-free areas and then transversally toward the mesentery; and (3) Injection in the severely affected lesions, that had a thickness of the intestinal wall over 10 mm, did not show any feature of lymphatic vessels at least on the subserosal surface. There was a correlation between the thickness of the parietal wall and the severity of the lymphatic alterations. Normal lymphatic vessels were observed at previous strictureplasties in the presence of complete regression of the inflammation. CONCLUSION:Injection of Patent Blue Ⅴ in the intestinal wall could help distinguish healthy tracts of the small bowel from those macroscopically borderline.

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Section: Discussionmentioning

confidence: 99%

Is lymphatic status related to regression of inflammation in Crohn's disease?

Tonelli

Giudici²,

Liscia³

2012

WJGS

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“…On CT enteroclysis, active inflammation is suggested by mural and wall enhancement, mural stratification, lymphadenopathy, engorgement of vessels, and wall thickness; fibrostenotic strictures, however, are associated with nonenhancing wall thickening, proximal dilation, and luminal stenosis (6). We did not apply semiquantitative or qualitative criteria for reading the intravenous contrast-enhanced CT scans as done in other studies (6)(7)(8)(9).…”

Section: Discussionmentioning

confidence: 99%

“…Noninvasive anatomic and functional imaging modalities, including CT enteroclysis (6)(7)(8)(9), CT enterography, ultrasound, magnetic resonance enterography, and radiolabeled white blood cell and granulocyte scintigraphy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), have shown some ability to measure the extent and severity of active inflammation in CD. Neither these techniques nor endoscopy allows complete assessment of transmural inflammation or extraluminal complications of CD.…”

mentioning

confidence: 99%

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Jacene¹,

Ginsburg²,

Kwon³

et al. 2009

J Nucl Med

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We preoperatively determined the accuracy of 18 F-FDG PET/CT for differentiating fixed muscle hypertrophy and fibrotic stenoses from acute transmural inflammatory stenoses in patients with Crohn's disease (CD) scheduled to undergo surgical resection for obstructive symptoms. Methods: Seventeen patients with known CD prospectively underwent 18 F-FDG PET/CT before already-planned surgery for obstructive symptoms. Image interpretation was by consensus of 2 readers with knowledge of patient participation in the study but not of other clinical history. Lesions were qualitatively graded on a 5-point scale for the presence of increased 18 F-FDG uptake consistent with active inflammation. Maximum lean standardized uptake value (SUL max ) was determined for lesions scored 1 or more. Imaging results were compared with the pathologic grading of inflammation and predominant histopathologic subtype for each patient's surgical specimen, whether mainly inflammation, fibrosis, or muscle hypertrophy. Results: Thirteen of the 17 patients underwent surgery (median, 28 d after PET/CT; range, 2-148 d), and 12 of these 13 had histopathologic correlation. Despite the predominant histopathologic subtype (inflammation, 5; fibrosis, 4; and muscle hypertrophy, 3), acute and chronic inflammation, fibrosis (median, 50%; range, 40%290%), and muscle hypertrophy (median, 20-fold thickening; range, 9-to 40-fold thickening) were found in all patients. SUL max was significantly higher in severe than in mild-to-moderate chronic inflammation (8.2 6 2.8 vs. 4.7 6 2.5, P 5 0.04). No patient with predominantly fibrosis or muscle hypertrophy (n 5 7) had an SUL max greater than 8. Visually, 10 of 12 patients on PET/CT were considered to have active inflammation of the bowel. Conclusion: Patients with CD who undergo surgery for obstructive symptoms have histopathologically mixed findings of inflammation, fibrosis, and muscle hypertrophy. Qualitative PET interpretations were quite sensitive, but additional semiquantitative analyses using SUL max helped identify patients with active inflammation. This information may be beneficial for referring gastroenterologists considering medical therapy versus surgery for patients with CD who present with obstructive symptoms.

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“…Moreover, in all probability, the fact that the operative specimens were ''opened'' for pathologic assessment erroneously reduced the number of reference diagnoses of stricture. In the same study [55], CT enterography displayed 77 % sensitivity and 86 % specificity in the detection of fistulas and somewhat greater accuracy in the identification of intra-abdominal abscesses (sensitivity 86 %, specificity 87 %). The recent systematic review by Panes et al [46] looked at the results of several studies and found that CT enterography had an overall sensitivity of 70 % and specificity of 97 % in the detection of fistulas.…”

Section: Computed Tomographymentioning

confidence: 72%

“…The systematic review conducted by Panes et al [46] looked at the performance of CT enterography in identifying areas of stenosis in five studies [50][51][52][53][54] and found an overall sensitivity and specificity of 89 and 99 %, respectively. This method was also assessed in an interesting study by Chiorean et al [55]: compared with intraoperative findings, CT enterography exhibited 92 % sensitivity with a specificity of only 39 %. The relative nonspecificity of the examination was probably related to the fact that data in this retrospective nature were collected from surgeons' reports.…”

Section: Computed Tomographymentioning

confidence: 99%

Surgery and diagnostic imaging in abdominal Crohn’s disease

et al. 2013

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Surgery is well-established option for the treatment of Crohn's disease that is refractory to medical therapy and for complications of the disease, including strictures, fistulas, abscesses, bleeding that cannot be controlled endoscopically, and neoplastic degeneration. For a condition like Crohn's disease, where medical management is the rule, other indications for surgery are considered controversial, because the therapeutic effects of surgery are limited to the resolution of complications and the rate of recurrence is high, especially at sites of the surgical anastomosis. In the authors' opinion, however, surgery should not be considered a last-resort treatment: in a variety of situations, it should be regarded as an appropriate solution for managing this disease. Based on a review of the literature and their own experience, the authors examine some of the possibilities for surgical interventions in Crohn's disease and the roles played in these cases by diagnostic imaging modalities.Riassunto La chirurgia è un'opzione terapeutica consolidata per il trattamento della malattia di Crohn refrattaria alla terapia medica e per le complicanze legate a tale patologia quali stenosi, fistole, ascessi, sanguinamento non trattabile endoscopicamente, oltre che per i casi di degenerazione neoplastica. Per condizioni come la malattia di Crohn nelle quali il trattamento medico ha un ruolo primario, altre indicazioni per la chirurgia sono controverse, poiché i suoi effetti terapeutici sono limitati alla risoluzione delle complicanze, e la frequenza di recidive è alta, soprattutto a livello dell'anastomosi. Secondo l'opinione degli autori, tuttavia, la chirurgia non deve essere considerata come ultima opzione di trattamento: in diverse situazioni dovrebbe essere ritenuta come una soluzione adeguata nel trattamento multidisciplinare della patologia. Basandosi sulla revisione della letteratura corrente e sulla propria esperienza, gli autori hanno esaminato alcune possibilità di intervento chirurgico nella malattia di Crohn ed il ruolo che svolgono in queste condizioni le tecniche di imaging.

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Correlation of CT Enteroclysis With Surgical Pathology in Crohn's Disease

Abstract: CTE may reliably differentiate between inflammatory and fibrostenotic lesions and may have an important role in the management of CD. Specific CTE variables correlate with each of these phenotypes and deserve further investigations in prospective studies.

Cited by 213 publications

References 32 publications

Is lymphatic status related to regression of inflammation in Crohn's disease?

Is lymphatic status related to regression of inflammation in Crohn's disease?

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT

Surgery and diagnostic imaging in abdominal Crohn’s disease

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Correlation of CT Enteroclysis With Surgical Pathology in Crohn's Disease

Abstract: CTE may reliably differentiate between inflammatory and fibrostenotic lesions and may have an important role in the management of CD. Specific CTE variables correlate with each of these phenotypes and deserve further investigations in prospective studies.

Cited by 213 publications

References 32 publications

Is lymphatic status related to regression of inflammation in Crohn's disease?

Is lymphatic status related to regression of inflammation in Crohn's disease?

Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by 18F-FDG PET/CT

Surgery and diagnostic imaging in abdominal Crohn’s disease

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Prediction of the Need for Surgical Intervention in Obstructive Crohn's Disease by ¹⁸F-FDG PET/CT