Raju Sharma MD, Presenter: Nothing to Disclose

Saurabh Kedia MD, Abstract Co-Author: Nothing to Disclose

Vineet Ahuja MD, Abstract Co-Author: Nothing to Disclose

Devasenathipathy Kandasamy, Abstract Co-Author: Nothing to Disclose

Birender Nagi MD, Abstract Co-Author: Nothing to Disclose

Intestinal tuberculosis (ITB) and Crohn’s disease (CD) have close clinical, radiological, endoscopic, and histological resemblance. There is lack of literature on computed tomography (CT) in differentiating between CD and ITB. Present study was designed to compare CT features of ITB and CD, and develop a predictive model to differentiate ITB and CD. 

All patients with ITB and CD, who underwent CT enteroclysis/CT enterography/CT abdomen before starting treatment, were recruited in the study. The gold standard for diagnosis of CD and ITB were ECCO guidelines and Paustian’s criteria respectively. The CT images were evaluated by 2 independent observers who were blinded to the diagnosis. 

One hundred eleven patients were included in the final analysis (60 CD, 51 ITB, mean age 36.4±14.2 years vs 34±13.3 years, p=0.36). Significantly more patients with ITB had short segment involvement (70.6% vs 26.7%, p < 0.001), ileocaecal involvement (49% vs 18.3%, p=0.001), <3 segments involved (84.3% vs 63.3%, p=0.002), and lymph nodes >1cm in size (19.6% vs 1.7%, p<0.001). Patients with CD had greater long segment involvement (61.7% vs 27.5%, p=0.006), presence of Comb’s sign (40% vs 19.6%, p=0.02), colonic involvement (35% vs 19.6%, p=0.072) and > 3 segments involved (25% vs 19.6%, p=0.138). Based on above features predictive models were developed which could differentiate ITB and CD with > 90% accuracy. 

Predictive models based on combination of CT findings to differentiate CD and ITB were developed, and they achieved an accuracy of >90%. 

CT is a robust modality for differentiating Intestinal Tuberculosis from Crohn's disease. Although overlapping findings do occur, certain combination of findings can differentiate between the two.

Sharma, R, Kedia, S, Ahuja, V, Kandasamy, D, Nagi, B, Role of CT in Differentiating Intestinal Tuberculosis from Crohn's Disease.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13044386.html