Joel Garland Fletcher MD, Abstract Co-Author: Research grant, Siemens AG Grant, E-Z-EM, Inc License agreement, General Electric Company

David Bruining MD, Presenter: Nothing to Disclose

Hassan Siddiki MD, Abstract Co-Author: Nothing to Disclose

James E. Huprich MD, Abstract Co-Author: Nothing to Disclose

Jeff Lynn Fidler MD, Abstract Co-Author: Grant, E-Z-EM, Inc, Lake Success, NY

William J. Sandborn MD, Abstract Co-Author: Research support, Johnson & Johnson Consultant, Johnson & Johnson Research support, Abbott Laboratories Consultant, Abbott Laboratories Research support, UCB SA Consultant, UCB SA Consultant, Elan Corporation, plc

Jaywant N. Mandrekar PhD, Abstract Co-Author: Nothing to Disclose

W. Scott Harmsen MS, Abstract Co-Author: Nothing to Disclose

Edward Loftus, Abstract Co-Author: Research grant, Abbott Laboratories Research grant, UCB SA Research grant, PDL BioPharma, Inc Research grant, The Procter & Gamble Company Research grant, Otsuka Pharmaceutical Co, Ltd Consultant, Abbott Laboratories Consultant, UCB SA Consultant, Elan Corporation, plc Consultant, The Procter & Gamble Company Consultant, PDL BioPharma, Inc Consultant, Bristol-Myers Squibb Company Consultant, Salix Pharmaceuticals, Inc Consultant, Shire plc

et al, Abstract Co-Author: Nothing to Disclose

Prior reports using endoscopic reference standards have validated individual CT enterography (CTE) findings as reflecting active histologic small bowel inflammation. In a prospective cohort of patients with established or suspected Crohn’s disease, we sought to compare the performance of historical, serum, and CTE markers of active inflammation to the final clinical assessment by a gastroenterologist.

273 patients with established or suspected Crohn’s disease underwent a detailed physical examination and CTE. Additional information was collected including historical CDAIs (Crohn’s Disease Activity Index) and serum studies (C-reactive protein, albumin, and hematocrit). A GI radiologist, blinded to clinical information, categorized CTE findings of active inflammation including mural hyperenhancement, wall thickness, stratification, Comb sign, and perienteric fat stranding. Reference standard for active disease presence or absence was determined by a gastroenterologist reviewing all available tests, using a 5-point confidence scale, with a score of 4 or 5 indicating active Crohn’s. Multivariable logistic regression was used to assess variables for significance, and ROC analysis comparing CTE findings to clinical data and laboratory parameters was performed.

Of the patients enrolled in the study, 148 were felt to have definite Crohn’s at the completion of their evaluation and were included in the analysis. All CTE findings associated with active mural inflammation were highly correlated with active disease (p ≤ 0.001), with AUC for individual findings ranging from 0.65 – 0.72. Historical CDAIs, elevated CRP, low albumin, and anemia were not highly associated with active inflammation (p = 0.15 – 0.72). AUC for optimal combination of CTE criteria demonstrated an AUC of 0.78 vs. optimal combination of clinical and serum studies with AUC of 0.61.

1. Integration of multiple CT enterography findings into the assessment of active Crohn’s disease improves overall CTE performance compared to individual CT findings with an AUC of 0.78. 2. CTE findings reflect Crohn’s disease activity better than historical CDAI and serum studies.

CT enterography findings reflect Crohn’s disease activity better than patient symptoms, history and serum markers.

Fletcher, J, Bruining, D, Siddiki, H, Huprich, J, Fidler, J, Sandborn, W, Mandrekar, J, Harmsen, W, Loftus, E, et al, , Prospective Comparison of CDAI, Serum Markers, and CT Findings as Predictors of Active Inflammation in Crohn’s Disease Patients undergoing CT Enterography (CTE).  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6018593.html