Philippe Alain Soyer MD, PhD, Presenter: Nothing to Disclose

Mourad Boudiaf MD, Abstract Co-Author: Nothing to Disclose

Sophie Grivaud MD, Abstract Co-Author: Nothing to Disclose

Florent Duchat MD, Abstract Co-Author: Nothing to Disclose

Roland Rymer MD, Abstract Co-Author: Nothing to Disclose

To prospectively determine the accuracy of CT-enteroclysis in diagnosing complications of Crohn’s disease in patients who had prior ileocolic resection.

After IRB approval, CT-enteroclysis was performed in 30 patients with suspected anastomotic recurrence of Crohn’s disease after ileocolic resection. Findings were blindly evaluated by two independant abdominal radiologists for the presence of preanastomotic ileal distension, degree of contrast enhancement, ileal thickening, stratification, anastomotic stenosis, adjacent adenopathies, increased vascularity, using a semi-quantitative scale. Final diagnosis was obtained using Crohn's disease activity index, Rutgeerts endoscopic score and pathologic findings.

Interobserver agreement was excellent for all CT-enteroclysis criteria, with Kappa values between 0.85 and 0.96. CT-enteroclysis showed ileal recurrence in 19 patients (19/30; 63%), in association with an anastomotic inflammatory stenosis in seven patients (7/30, 23%), fibrostenotic stricture in five patients (5/30, 17%), preanastomotic fistula in one patient (1/35, 3%) and normal findings in eight patients (8/30, 27%). The accuracy of CT-enteroclysis for recurrence, inflammatory stenosis and fibrostenotic stricture was 93%, 95% and 91%, respectively. Combination of criteria had 99% specificity and 98% sensitivity for anastomotic site classification.

CT-enteroclysis provides robust, objective and specific morphological criteria to differentiate between inflammatory recurrence and fibrostenotic stricture after ileocolic resection in patients with Crohn’s disease.

CT-enteroclysis allows accurate differentiation between inflammatory stenosis and fibrostenotic stricture after ileocolic resection and thus has substantial impact on management.

Soyer, P, Boudiaf, M, Grivaud, S, Duchat, F, Rymer, R, Suspected Anastomotic Recurrence of Crohn’s Disease after Ileocolic Resection: Prospective Evaluation with CT-enteroclysis.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6015737.html