Clinical correlations of small bowel CT and contrast radiology findings in Crohn’s disease

L. Guidi, L.M. Minordi*, S. Semeraro, I. De Vitis, I. Roberto, S. Ennas, S. Guglielmo, L. Di Candia, A. Papa, R. Urgesi, A. Grillo, M.G. Brizi*, A. Vecchioli*, G. Fedeli

Departments of Internal Medicine
* Departments of Radiology
Catholic University of the “Sacred Heart”, Rome (Italy)

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• Gastroenterology

Backgrounds and Objective: Aim of the present study was to evaluate the clinical correlates of small bowel CT patterns in patients with Crohn’s disease (CD), as compared to barium studies and endoscopic findings, as far as parameters of disease activity are concerned.

Material and Methods: Thirty five patients with pathologically proven CD were studied by means of helical single detector CT (13) or multidetector CT (22), after administration of low density contrast by mouth (13) or by nasojeunal tube (22). Eight hours later, all patients were studied with barium administered by mouth (13) or with barium and methilcellulose administered by nasojeunal tube (22). Clinical activity was assessed by CDAI score, ESR, CRP, alpha1 glycoprotein and fibrinogen levels. In twenty one patients, colonoscopy was also performed.

Results: Sensitivity of small bowel CT versus endoscopy was of 88% while sensitivity of barium studies was of 77% versus endoscopic findings, and it reached 100% for the combination of both exams. We found positive correlations between the detection at CT of “target sign” and a CDAI score > 150 or abnormal values of CRP, ESR, a1glycoprotein. Abnormal ESR or fibrinogen levels were correlated with the detection of fistulas at CT scans. The diameter of enlarged mesenteric lymph nodes was correlated with a1glycoprotein values. No similar correlations were detected for contrast radiology findings.

Discussion: This study underscores the clinical usefulness of performing small bowel CT in adjunct to conventional diagnostic studies in Crohn’s disease patients. CT findings (either by oral route or nasojeunal tube) correlate with parameters of disease activity.

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