Cherry Kim MD, Presenter: Nothing to Disclose

Seong Ho Park MD, Abstract Co-Author: Research Grant, DONGKOOK Pharmaceutical Co, Ltd Research Grant, General Electric Company

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

Sang Hyoung Park, Abstract Co-Author: Nothing to Disclose

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

Complete remission (CR) of inflammation, i.e. mucosal healing, using anti-TNF-α has become a treatment goal for Crohn's disease (CD). This study was to investigate the findings and roles of CT enterography (CTE) in CD showing CR at colonoscopy after anti-TNF-α therapy.    

34 consecutive CD patients, who had shown colonoscopic CR after anti-TNF-α therapy and had undergone CTE within 1 month of the CR, were included. CTE of 32 colons and 24 terminal ilea found to have endoscopic CR were analyzed regarding CTE findings of bowel inflammation (wall thickening, mural hyperenhancement, perienteric edema/infiltration, comb sign, and findings of penetrating disease) and other abnormalities. CTE findings at the time of CR were compared with pre-treatment CTE findings if available (in 26 patients). The incidence of various CTE findings at the time of endoscopic CR and their association with treatment length, demographic and pre-treatment disease characteristics, and patient course/outcome after the achievement of CR (median follow up, 17 months) was analyzed.  

25 (45%) of 56 bowels in 21 (62%) patients showed one or more findings of inflammation on CTE at CR, although remarkably decreased compared with pre-treatment state: mural hyperenhancement (n=19), mural thickening (n=14), and comb sign (n=4). Bowel deformities (contraction, pseudosacculation, and loss of haustration) (n=15) mostly persisted with occasional reversal of loss of haustration. There was no significant difference in treatment length between patients who showed residual inflammation on CTE (6-49 months; median, 14) and those who did not (10-58 months; median 13) (P=0.944). Also, the residual bowel inflammation as seen on CTE at the time of CR was not significantly associated with demographic or pre-treatment disease characteristics or the post-CR patient course/outcome.

CTE showed incomplete resolution of inflammatory findings in 45% of the bowels (62% of the patients) despite endoscopic CR state after anti-TNF-α therapy. The residual CTE abnormalities appear not to have clinical relevance or prognostic implications and, thus, should not indicate insufficient treatment as long as there is a remarkable decrease in the inflammatory findings on CTE.

CTE can be used more accurately and effectively to monitor the treatment response to anti-TNF-α in CD patients by understanding the CTE findings of endoscopic CR.  

Kim, C, Park, S, Yang, S, Park, S, Ha, H, Findings and Roles of CT Enterography in Patients with Crohn's Disease Showing Complete Remission at Colonoscopy after Treatment with Anti-TNF-α.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14005584.html