The Diagnostic Value Of Multi-slice Computer Tomography Enterography In Crohn’s Disease

Background:Crohn’s disease (CD) is a chronic inflammatory granulomatous disease with unknown etiology. It can affect any portion of the gastrointestinal tract, such as the esophagus, stomach, duodenum, the small bowel, colon, while the terminal ileum and proximal colon are most commonly affected. The treatment of CD depends on not only the extent and the severity of the disease, but also patient’s responsiveness to previous treatments and the condition of individual patient. So it is important to identify the affected portion and evaluate the activity of CD. So far lots of diagnostic tools can help to diagnose CD such as ileocolonoscopy, barium enema examination, double balloon enteroscopy (DBE). They have their own advantages and disadvantages. Nowadays multi-slice computer tomography enterography (MSCTE) becomes the common non-invasive diagnostic tool. However its diagnostic value is still controversial.Aim:To explore the sensitivity and specificity of the MSCTE in diagnosing the extent of CD, the relationship between MSCTE and CRP/ESR of CD patients, the relationship between MSCTE and the activity of CD, and the relationship between MSCTE and DBE.Methods:50patients with known or suspected CD undergoing MSCTE in Zhongshan Hospital from June2010to February2012were chosen as group A. Clinical data included history, physical exam, laboratory tests, colonoscopy and MSCTE findings (abnormal mucosal vascularity, bowel wall thickening, mucosal enhancement, intestinal stenosis or distension, lymph node enlargement, fistula formation) were collected. We analyzed the accuracy and reliability of MSCTE in detecting colorectal lesions. SPSS15.0was used for the statistical analysis of the correlation between MSCTE findings and CRP/ESR in CD and the correlation between MSCTE findings and the activity of CD.81patients undergoing MSCTE and DBE in Zhongshan Hospital from April2009to February2012were chosen as group B. Clinical data included history, MSCTE findings and DBE findings were collected. We analyzed the accuracy and reliability of MSCTE in detecting inflammatory lesions. SPSS15.0was used for the statistical analysis of the MSCTE findings and DBE findings in CD patients.Results:Group A:(1) MSCTE findings showed5patients (5/50) were affected only in colorectum,19patients (19/50) were affected only in small intestine,22patients (22/50) were affected both in colorectum and small intestine, and one patient (1/50) was affected in gastric antrum. The sensitivity of MSCTE in detecting colorectal lesions in CD was12/15, while the specificity was4/7. Kappa value was0.371(P>0.05).(2)MSCTE findings showed14patients (14/50) were with abnormal mucosal vascularity,43patients (43/50) were with bowel wall thickening (above4millimeter),39patients (39/50) were with mucosal enhancement,29patients (29/50) were with lymph node enlargement,25patients (25/50) were with intestinal stenosis or distension and3patients (3/50) were with fistula formation.(3)CRP may be correlated with lymph node enlargement and intestinal stenosis or distension (R>0.2, P>0.05). ESR may be correlated with abnormal mucosal vascularity and lymph node enlargement (R>0.2, P>0.05).(4) The activity of CD may be correlated with abnormal mucosal vascularity (R>0.2, P>0.05).Group B:(1)30.9percent of the patients were suspected intestinal hemorrhage and25.9percent were with abdominal pain.46.9percent of the patients showed inflammatory lesions and23.5percent showed intestinal tumor in their MSCTE findings.51.9percent of the patients showed inflammatory lesions and19.8percent showed intestinal tumor in their DBE findings.(2) The sensitivity of MSCTE in detecting inflammatory lesions was30/42, while the specificity was31/39. Kappa value was0.507(P>0.05).(3)22patients (22/38) who showed inflammatory lesions in MSCTE findings were ultimately diagnosed with CD.(4)29patients were ultimately diagnosed with CD in group B. MSCTE findings showed4patients (4/29) were with abnormal mucosal vascularity,23patients (23/29) were with bowel wall thickening,21patients (21/29) were with mucosal enhancement,11patients (11/29) were with lymph node enlargement and14patients (14/29) were with intestinal stenosis or distension. Conclusions:CD most commonly affects colorectum and small intestine. MSCTE examination has excellent potential to discover small intestinal and colorectal lesions. MSCTE findings can help to evaluate the clinical activity of CD. CD should always be suspected when the patient shows inflammatory lesions in MSCTE findings. The relationship between MSCTE findings and CRP/ESR is still controversial and further studies are necessary.