Differential Diagnosis Between Crohn’s Disease And Intestinal Tuberculosis Or Primary Intestinal Lymphoma

PART Ⅰ Differential Diagnosis Between Crohn’s Disease and Intestinal TuberculosisAim: Evaluate the value of clinical manifestations,T-SPOT,endoscopic and CT enterographic features to differentiate Crohn’s disease(CD)from intestinal tuberculosis(ITB).Methods: 128 inpatients with suspected CD and ITB were enrolled in our observational cohort.Demographic,clinical,laboratory,endoscopic and CT enterographic data were collected.After treatment for 6 months,when a definite diagnosis was reached,the differential diagnostic value of each parameter was analyzed.Grade each valuable parameter according to its specificity and set up a final differential model.Results: Clinical parameters favoring in differentiating CD from ITB included diarrhea,night sweat and perianal lesions.T-SPOT yielding high sensitivity and negative predictive value for ITB.Endoscopic parameters favoring in differentiating CD from ITB including transverse ulcers,longitudinal ulcers,rodent-like ulcers and patulous ileocecal valve.CT enterographic parameters likely for identification of the two conditions included skip lesions,asymmetric pattern of involvement,contracture of the ileocecal valve,fixed patulous ileocecal valve,lymph node with central necrosis,lymph node with calcification,ascites,comb sign,phlegmon and fistula.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the differentiating model were 93.5%,93.5%,93.5%,96.6% and 82.9% respectively.The cut-off value was 1.5.Area under the ROC curve(AUC)was 0.985.Conclusions: Differentiating CD from ITB reasonably requiring a proper grading system that needs combining clinical manifestations,T-SPOT,endoscopic and CT enterographic parameters together so as to increase diagnostic accuracy.PART Ⅱ Differential diagnosis between Crohn’s disease and primary intestinal lymphomaAim: Evaluate the value of demography,clinical manifestations,laboratory test,endoscopic parameters and CT enterographic features to differentiate Crohn’s disease(CD)from primary intestinal lymphoma(PIL).Methods: Medical records of 85 patients with CD and 56 patients with PIL were reviewed retrospectively.Demographic,clinical,laboratory,endoscopic and CT enterographic parameters were collected.The value of each parameter was analyzed.Grade each valuable parameters according to its specificity and set up a final differential model.Results: Demographic and clinical parameters favoring in differentiating CD from PIL included age of onset,duration of symptoms,diarrhea,abdominal mass and perianal lesions.Elevated lactate dehydrogenase(LDH)and serum β2-microglobulin(β2-MG)indicated a PIL diagnosis.Endoscopic parameters favoring in differentiating CD from PIL included multiple-site lesions,longitudinal ulcer,irregular ulcer and intraluminal proliferative mass.CT enterographic parameters aided identification of the two conditions included involvement segments≤3,circular thickening of bowel wall,wall thickness>8mm,aneurysmal dilation,stricture with proximal dilation,comb sign,mass of sandwich sign and intussusceptions.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the differentiating model were 92.9%,96.4%,94.3%,97.5% and 90.0% respectively.The cut-off value was 0.5.Area under the ROC curve(AUC)was 0.989.Conclusions: CD and PIL have overlapping features,which continuously perplex clinicians.Some valuable parameters in differentiating these two conditions do exist regarding clinical manifestations,laboratory test,endoscopic features and CT enterographic characteristics.The differential model integrating various parameters together yields high diagnostic efficacy which should be further proved and verified.