Abstract:
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Purpose: To compare the diagnostic accuracies of enteroclysis, sonography, and AgAb SPECT in diagnosing early and late ileocecal Crohn's disease (CD) and in assessing morphologic activity.
Methods and Materials: A retrospective analysis of the studies of 54 patients (30 females, 24 males, ages of 18-71) with verified CD (operation: 8, biopsy: 50 cases) located to the ileocecal region was made. All patients had enteroclysis, sonography (4-8 MHz receiving frequency with Native Tissue Harmonic Imaging, and duplex Doppler measurement of the flow in the superior mesenteric artery /SMA/) and 45 of them had 99mTc AgAb immunoscintigraphy with SPECT. Activity was determined by the presence of ulcerations or fistulas in enteroclysis. The results were compared.
Results: Overall sensitivity of enteroclysis, sonography and immunoscintigraphy was 100%, 89% and 71%. In early Crohn's disease (12 cases) the sensitivities were 100%, 75% and 40% respectively. In detecting morphologically active disease immunoscintigraphy had 70% sensitivity, 33% specificity. Increased SMA flow had 76% sensitivity; 100% specificity, while wall thickening (> 3mm) had 92% sensitivity; 33%specificity. Using a combined sonographic criteria (presence of destroyed wall stratification or detection of fistulas or abscesses or increased SMA flow) 96% sensitivity and 100% specificity could be obtained. Surgical indications (fistulas or abscesses) were detected in 6/8 cases by both enteroclysis and sonography.
Conclusion: Although the sensitivity of sonography in early CD is not sufficient for detecting suspected CD, for follow up in advanced cases sonography could replace enteroclysis. New combined sonographic criteria give excellent correlation with morphologic activity determined by enteroclysis. Sensitivity for detecting abscesses might compensate for missed fistulas.
Questions about this event email: tarjan@radi.sote.hu
Tarjan MD, PhD, Z,
Diagnosis and Activity of Ileocoecal Crohn's Disease: Comparison of US, Enteroclysis and AgAb SPECT. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3106063.html
