Laura Maria Minordi

CT findings and clinical activity in Crohn's disease

The aim of this study was to evaluate clinical correlations of CT signs in proven Crohns disease. Fifty patients were studied by means of multidetector CT. Clinical activity was assessed using Crohns disease activity index (CDAI) score and some laboratory parameters. All patients with CDAI>150 had CT study scored as pathological. Seventy-nine percent of patients with CDAI<150 showed abnormalities in CT exam. CT findings correlate with some parameters of disease activity, thus underlining the usefulness of performing CT enteroclysis in Crohns disease patients.

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

OBJECTIVES CT is nowadays an examination routinely performed in Crohns disease (CD) patients. However, there are several ways to assess gastro-intestinal tract, in particular colonic segments. Aim of this study is to compare enterography-CT (E-CT), performed after oral administration of polyethylene-glycol solution (PEG-CT) versus enterography-CT performed also with water enema via rectum (ECT-WE) in patients with CD. METHODS We have studied 79 patients with CD undergone to enterography-CT (42 evaluated with PEG-CT and 37 with ECT-WE) who have performed a lower endoscopy within 15 days before CT. CT results concerning large bowel were compared with endoscopic findings. Intestinal distension, discomfort of the patients, sensitivity, specificity and diagnostic accuracy were evaluated. Pearson test was used for statistical analysis. RESULTS Degree of abdominal pain was significantly higher in patients underwent to ECT-WE compared to PEG-CT. Distension of the colon was significantly greater in patients studied with ECT-WE compared to those studied with PEG-CT. Values of sensitivity, specificity and diagnostic accuracy of PEG-CT and ECT-WE were respectively 77, 86.5 and 81%, and 89, 100 and 92% in comparison with endoscopy. CONCLUSIONS In patients with CD, ECT-WE allows the evaluation of large bowel in addition to small bowel better than PEG-CT.

Multiparametric Evaluation Predicts Different Mid-Term Outcomes in Crohn’s Disease

Aim: To evaluate if a single and/or combined (clinical, endoscopic and radiological) assessment could predict clinical outcomes in Crohn’s disease (CD). Methods: We prospectively evaluated 57 CD cases who underwent both a colonoscopy and a CT-enterography (CTE). Harvey-Bradshaw Index (HBi), SES-CD (and/or Rutgeerts score) and the radiological disease activity were defined to stratify patients according to clinical, endoscopic and radiological disease activity respectively. Hospitalizations, surgery, therapeutic changes and deaths were evaluated up to 36 months (time 1) for 53 patients. Results: CTE and endoscopy agreed in stratifying disease activity in 47% of cases (k = –0.05; p = 0.694), CTE and HBi in 35% (k = 0.09; p = 0.08), endoscopy and HBi in 39% (k = 0.13; p = 0.03). Taken together, CTE, endoscopy and HBi agreed only in 18% of cases (k = 0.01; p = 0.41). Among the 11 cases with mucosal healing, only 3 (27%) showed transmural healing. Patients with endoscopic activity needed significantly more changes of therapy compared to patients with endoscopic remission (p = 0.02). Patients with higher transmural or clinical activity at baseline required significantly more hospitalizations (p < 0.01). Hospitalization rate decreases with an increase in the number of parameters indicating remissions at baseline (p = 0.04). Conclusions: Clinical, endoscopic and radiological assessments offer complementary information and could predict different mid-term outcomes in CD.

Crucial Additional Value of Enteroscopy in the Diagnosis, Assessment, and Further Management of Small Bowel Crohn’s Disease

The diagnosis of Crohn’s disease is challenging as it combines clinical and laboratory clues with endoscopic, radiological and histological findings [1, 2]. Consequently, the diagnosis is often delayed or the disease is misdiagnosed, in particular in the case of mainly or exclusively ileal or jejunal involvement [3]. Enteroscopy enables deep intubation, with endoscopic visualization of the small bowel and otherwise complicated or unobtainable tissue sampling. In a secondarytertiary center, based on a strong clinical suspicion of inflammatory bowel disease (IBD) with laboratory findings consistent with Crohn’s disease, radiology could be the first step in making a diagnosis, followed directly by enteroscopy if there are clear signs of jejunal or ileal localization. This is a “top down” strategy in the diagnosis of Crohn’s disease, that might be effective in patients in whom the diagnosis is delayed.

A Collection of Clinical Cases

A 24-year-old man with a recent onset of intermittent diarrhea, mild diffuse abdominal pain, as well as weight loss.

Radiological Diagnosis of Small-Bowel Diseases

A combination of different radiological techniques allows the correct evaluation of patients with suspected small-bowel disease, particularly Crohn’s disease and small-bowel neoplasms. Barium studies provide only indirect information on the intestinal wall and adjacent extraintestinal structures whereas with US, CT, and MRI direct visualization of the wall (thickness and structure) and adjacent extraintestinal structures (mesentery, perivisceral fibrofatty cells, lymph nodes, peritoneal spaces) is possible. In particular, CT-enteroclysis and MRI-enteroclysis show mucosal alterations and the morpho-functional characteristics of the small-bowel loops. CT findings have been shown to correlate with the clinical activity index of Crohn’s disease.