Enteroclysis CT and PEG-CT in patients with previous small-bowel surgical resection for Crohn’s disease: CT findings and correlation with endoscopy

Abstract

The aim of this study was to evaluate the accuracy of multidetector CT in patients with Crohn's disease (CD) relapse after ileocolic resection compared with endoscopy. Thirty-four patients were studied by endoscopy and multidetector CT, after oral administration of polyethylene glycol solution (n = 21) or after administration of methylcellulose via nasojejunal tube (n = 13). In CT examinations we evaluated the presence of mural thickening, target sign, perienteric stranding, comb sign, fibrofatty proliferation and complications. Endoscopic results were classified in accordance with Rutgeerts score (from 0 to 4). The statistical evaluations were carried out by using Fisher's exact text and chi (2) testing (p < 0.05, statistically significant difference). Sensitivity, specificity and accuracy of the CT were 96.9%, 100% and 97%, respectively. We found a statistically significant correlation between an endoscopic score of 4 and the CT signs of target sign, perienteric stranding, comb sign and fibrofatty proliferation, and between scores 1 and 2 and mucosal hyperdensity without or with mural thickening, respectively (p < 0.05). Moreover, only CT identified the presence of jejunal and proximal ileum disease in two and three patients, respectively, and fistulas in three patients. CT is a reliable method in the diagnosis of CD relapse and shows agreement with the approved endoscopic Rutgeerts score.

Crohn’s disease: prevalence of intestinal and extraintestinal manifestations detected by computed tomography enterography with water enema

“…Upper gastrointestinal (gastroduodenal) forms are rarely observed [1]. In CD recurrence after bowel resection surgery, there is a predilection for the neoterminal ileum [2,3].…”

Enterography CT without and with water enema in patients with Crohn’s disease: Results from a comparative observational study in comparison with endoscopy

“…Concerning the medium contrast agent used to obtain the bowel distension, in literature we found oral use of oil emulsions, water, air, Mucofalk and PEG [16,17]. Maglinte et al proposed a suspension of 0.1% barium sulphate (Volumen) for oral use [18].…”

CT and MR enterography in Crohn’s disease: current and future applications

“…Unfortunately, no widely accepted scoring system for CD severity assessment currently exists. Minordi et al performed CTE in 34 patients with suspected relapse following ileocolonic resection and development of a semiquantitative score system (CTE0-CTE3) ( Table 1) using the endoscopic Rutgeerts score [30]. A further prospective study of 32 patients has validated its usefulness in predicting the rate of re-operation [31].…”

“…A semi-quantitative score system (CTE0-CTE3) adapted from the Rutgeerts score was originally described by Minordi et al [30] Rutgeerts Endoscopic findings CTE CTE findings i0…”