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Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn's disease

Adler, Jeremy MD, MSc1,*; Punglia, Darashana R. MD2; Dillman, Jonathan R. MD3; Polydorides, Alexandros D. MD, PhD4; Dave, Maneesh MBBS, MPH5; Al-Hawary, Mahmoud M. MD6; Platt, Joel F. MD6; McKenna, Barbara J. MD4; Zimmermann, Ellen M. MD7

doi: 10.1002/ibd.21801
Original Article: Original Clinical Articles

Background: It has become commonplace to categorize small intestinal Crohn's disease (CD) as “active” vs. “inactive” or “inflammatory” vs. “fibrotic” based on computed tomography enterography (CTE) findings. Data on histologic correlates of CTE findings are lacking. We aimed to compare CTE findings with histology from surgically resected specimens. We tested the hypothesis that CTE findings can distinguish tissue inflammation from fibrosis.

Methods: Patients who underwent CTE within 3 months before intestinal resection for CD were retrospectively studied. Radiologists blinded to history and histology scored findings on CTE. Pathologists blinded to history and imaging scored resected histology. We compared histology with CTE findings and radiologists assessment of whether the stricture was likely “active” or “inactive.”

Results: In all, 22 patients met inclusion criteria. Inflammatory CTE findings correlated with histologic inflammation (rho = 0.52). Strictures believed to be “active” on CTE were more inflamed at histology (P = 0.0002). Strictures lacking inflammatory findings on CTE or considered “inactive” were not associated with greater histologic fibrosis or significant histologic inflammation. Upstream dilation was associated with greater tissue fibrosis in univariate (P = 0.014) but not in multivariate analysis (P = 0.53). Overall, histologic fibrosis correlated best with histologic inflammation (rho = 0.52). Strictures on CTE with the most active disease activity also had the most fibrosis on histology.

Conclusions: CTE findings of mesenteric hypervascularity, mucosal hyperenhancement, and mesenteric fat stranding predict tissue inflammation. However, small bowel stricture without CTE findings of inflammation does not predict the presence of tissue fibrosis. Therefore, caution should be used when using CTE criteria to predict the presence of scar tissue. (Inflamm Bowel Dis 2011;)

1 Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan

2 Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan

3 Section of Pediatric Radiology, Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan

4 Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan

5 Department of Internal Medicine, Wayne State University, Detroit, Michigan

6 Department of Radiology, Division of Abdominal Imaging, University of Michigan Health System, Ann Arbor, Michigan

7 Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan

* University of Michigan, 1150 W. Medical Center Dr., A520B MSRB I, Box 5658, Ann Arbor MI 48109

Additional Supporting Information may be found in the online version of this article.

Email: jeradler@umich.edu

Received 21 April 2011; Accepted 20 May 2011

Published online 24 June 2011 in Wiley Online Library (wileyonlinelibrary.com).

Funded by National Institutes of Health NIDDK R01 DK073992 (to E.M.Z.) and NICHD K12 HD028820 (to J.A.).

© Crohn's & Colitis Foundation of America, Inc.
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