Kumaresan Sandrasegaran MD, Abstract Co-Author: Grant, Koninklijke Philips Electronics NV, Cleveland, OH

Michael V. Chiorean, Abstract Co-Author: Nothing to Disclose

Dean Daniel T. Maglinte MD, Presenter: Consultant, Cook Group Incorporated, Bloomington, IN Consultant, E-Z-EM, Inc, Westburg, NY

To determine the accuracy of CT enteroclysis (CTE) in differentiating inflammatory and fibrostenotic strictures in patients with Crohn’s disease.

Retrospective review of CTE database was performed to identify patients with CD who had preoperative CTE. CTE findings were reviewed, blinded to pathology findings, for mucosal and mural enhancement, wall thickness, mesenteric vascularity and the presence of adenopathy and strictures. The presence of inflammation and fibrostenosis were scored on 4- and 3-point scales, respectively. Patients were excluded if they had non-resective surgeries or a diagnosis of malignancy.

Of the 54 patients enrolled, 10 were excluded. The remaining patients (61% female, 84% white) underwent 44 surgical interventions generating 47 bowel segments that were pathologically analyzed. The accuracy of CTE for inflammatory and fibrostenotic lesions was 76.6% and 78.7%. There was good correlation of pathological findings with CTE inflammatory (Spearman’s r=0.7, p<0.0001) and fibrostenosis (r=0.6, p<0.0001) scores. The pathological presence of inflammation was significantly associated with CTE findings of mucosal hyperenhancement and mesenteric hypervascularity (Mantel-Haenszel Chi-square p=0.04, and <0.0001, respectively). The pathological presence of fibrostenosis was significantly associated with the presence mural thickening and absence of mesenteric hypervascularity (p=0.001 and 0.007, respectively).

CTE may reliably differentiate between inflammatory and fibrostenotic lesions and may have an important role in the management of Crohn’s disease.

Standard diagnostic tests cannot reliably differentiate between inflammatory and fibrostenotic lesions. Such differentiation has management implications since treatment of these lesions is different. We have shown that CT enteroclysis can accurately differentiate between these subtypes of Crohn’s disease.

Sandrasegaran, K, Chiorean, M, Maglinte, D, Differentiation of Inflammatory and Fibrostenotic Strictures in Crohn’s Disease Using CT Enteroclysis.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5006145.html