Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”

Meyers, Morton A.; McGuire, Patrick

doi:10.1007/bf00203365

Cited by 164 publications

(53 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The CTE finding of either enteric signs such as mural stratification and hyperenhancement or perienteric signs like mesenteric hypertrophy or engorged vasa recta, the socalled ''comb sign'', has been found to correlate either with endoscopic or histological inflammation or with acutephase proteins, with sometimes discrepant results [6,7,[10][11][12]. The importance of recognising the different patterns of disease, especially early in the disease course, may help in tailoring specific therapies, predicting future complications, and possibly offering better timing of surgical interventions [13].…”

Section: Introductionmentioning

confidence: 99%

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Cappello

Tudisca

et al. 2014

Radiol med

View full text Add to dashboard Cite

Purpose Few studies have correlated computed tomography enterography (CTE) findings with Crohn's disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. Materials and methods The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and complications related to the disease (fistulas, strictures, abscesses). Activity was assessed using the Crohn's Disease Activity Index (CDAI) and some biochemical markers (Creactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correlations between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. Results CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). Conclusion The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clinically active and that these patients may require more aggressive treatment than patients without these findings.

show abstract

Section: Introductionmentioning

confidence: 99%

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Cappello

Tudisca

et al. 2014

Radiol med

View full text Add to dashboard Cite

show abstract

“…6 These findings allow MRI to have an important role in the short-and long-term follow-up of stricturoplasty. With active inflammation there is increased vascularity to the bowel segment, which produces engorgement of the vasa recta forming the ''comb sign'' 45 ; it appears as multiple tubular, tortuous opacities, on the mesenteric side of the ileum, aligned like the teeth of a comb (Fig. 10).…”

Section: Mri Findingsmentioning

confidence: 99%

Guide to magnetic resonance in Crohnʼs disease

Mazziotti

Ascenti

Scribano

et al. 2011

Inflammatory Bowel Diseases

View full text Add to dashboard Cite

Considering that multiple imaging examinations are often necessary for monitoring Crohn's disease (CD) activity and severity in order to guide and monitor appropriate treatment, the ideal imaging test would be reproducible, well tolerated by patients, and free of ionizing radiation. For these reasons recent studies have highlighted the role of a magnetic resonance imaging (MRI) technique optimized for small bowel imaging in the evaluation of small bowel disorders. In this regard there are two main methodological approaches represented by MR enterography, following administration of an oral contrast medium, and MR enteroclysis, following administration of contrast medium through a nasojejuneal tube. MRI may be used to demonstrate the pathologic findings and complications of CD. In particular, MR has excellent sensitivity and specificity, ranging from 88%-98% and 78%-100%, respectively, for the detection of active inflammation, wall thickening, ulcerations, increased wall enhancement, increased vascularity, perienteric inflammation, and reactive adenopathy. MR also allows more accurate identification of associated complications including penetrating and fibrostenotic disease as well as the more rare extraintestinal manifestations that are usually associated with severe and longstanding intestinal inflammation, the latter often guiding the therapeutic approach. In the progression of CD some rare complications can occur that, to our knowledge, were only briefly or never mentioned in the radiological literature regarding MR enterography or enteroclysis and in which the application of these techniques play a key role.

show abstract

“…This has been associated with 90% cases of Crohn's disease. Tortuosity and dilatation of vasa recta in the small bowel mesentery is a feature of active Crohn's disease and has been described as the comb sign on CT [9]. The presence of prominent vasculature around the small bowel or large bowel is seen in 81% of patients with active Crohn's disease.…”

Section: Ct Imagingmentioning

confidence: 99%

“…3, 4) [2][3][4][5][6][7][8][9]. The presence of multilayered wall stratification or two-layer stratification with strong mucosal enhancement and low-density prominence of submucosa have been associated with the presence of active inflammatory activity in 91 and 100% cases of Crohn's disease, respectively [10].…”

Section: Ct Imagingmentioning

confidence: 99%

Imaging of Inflammatory Bowel Disease: CT and MR

Zalis

Singh

2004

Dig Dis

View full text Add to dashboard Cite

Cross-sectional imaging has come to play a central role in the imaging of the abdomen. Concurrent to this, the role of CT and MRI in the imaging of inflammatory bowel disease has also increased in importance. These modalities offer numerous advantages over more traditonal methods of radiologic diagnosis, and provide essential information not only for initial diagnosis, but for management, follow-up and detection of potential complications. On the horizon are several derivative techniques involving CT and MRI, potentially in combination with PET imaging; these may further improve the specificity and sensitivity of imaging modalities for diagnosis of inflammatory bowel disease.

show abstract

Spiral CT demonstration of hypervascularity in Crohn disease: “vascular jejunization of the ileum” or the “comb sign”

Abstract: Clinical application of these observations may enhance the diagnosis of Crohn disease presenting initially or as an acute recurrence in the differential diagnosis from other conditions.

Cited by 164 publications

References 33 publications

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: relationship of CT findings with CDAI and acute-phase reactants

Guide to magnetic resonance in Crohnʼs disease

Imaging of Inflammatory Bowel Disease: CT and MR

Contact Info

Product

Resources

About