Seung Soo Lee MD, Presenter: Nothing to Disclose

Ah Young Kim MD, Abstract Co-Author: Nothing to Disclose

Seong Ho Park MD, Abstract Co-Author: Nothing to Disclose

Hyun Kwon Ha MD, Abstract Co-Author: Nothing to Disclose

Jun-Won Chung MD, Abstract Co-Author: Nothing to Disclose

Suk-Kyun Yang MD, Abstract Co-Author: Nothing to Disclose

To prospectively compare CT enterography (CTE), MR enterography (MRE), and small-bowel follow-through (SBFT) for the detection of active inflammation in the small intestine and complications in the same patients with Crohn’s disease.

Institutional review board approval and informed consent were obtained. 30 consecutive patients with Crohn’s disease underwent CTE and MRE, SBFT, and Ileocolonoscopy. Two reviewers performed independent blind review of CTE, MRE, and SBFT and identified active inflammation in the small intestine and complications. Regarding the terminal ileum, the reader’s confidence for the presence of active inflammation was graded using a five point scale. With ileocolonoscopic findings as reference standards, the accuracies of CTE, MRE, and SBFT in the depiction of active inflammation in terminal ileum were evaluated using the receiver operating characteristic method. Agreements between two reviewers were analyzed using weighted kappa statistics. CET, MRE, and SBFT were compared for the identification of complications.

Accuracies of CTE, MRE, and SBFT in the detection of active inflammation in the terminal ileum were similar. The differences in the area under the curve of CTE (0.900, 0.894), MRE (0.933, 0.950), and SBFT (0.883, 0.928), were not statistically significant for both reviewers. Interobserver agreements were excellent or good for CTE (.812) and MRE (.718), but moderate for SBFT (.542). Among 10 surgically or colonoscopically proven complications (enteric fistulae [n=4], sinus tracts [n=3], and abscess cavities [n=3]), both CTE and MRE detected all of them, but SBFT identified only three (fistulae [n=2] and sinus tract [n=1]).

Compared with SBFT, CTE and MRE can depict active small bowel inflammation with similar accuracy and with higher inter-observer agreement, and can detect more complications in patients with known Crohn’s disease. Given comparable diagnostic accuracy of CTE and MRE, MRE can be utilized as a radiation-free alternative method for the evaluation of Crohn’s disease.

As a follow-up imaging tool for patients with known Crohn’s disease, either CTE or MRE can potentially replace SBFT.

Lee, S, Kim, A, Park, S, Ha, H, Chung, J, Yang, S, Active Crohn’s Disease: A Prospective Comparison Study among MR Enterography, CT Enterography, and Small Bowel Follow-through.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5009896.html