MDCT distinguishes active Crohn's disease from chronic condition
Multidetector CT enterography can not only assess Crohn's disease and its activity. It can also identify whether patients are suffering from active or chronic variations of the condition, University of Michigan researchers reported at the 2003 RSNA meeting.
Such a differentiation could help determine whether to treat patients with traditional drug therapies or surgery, said Dr. Joel F. Platt, director of the abdominal imaging division at Michigan.
Platt and colleagues performed 17 examinations on 16 patients with a 16-slice MDCT scanner, using water as an oral contrast agent. Reviewers blinded to both clinical and laboratory findings examined axial and 3D images. CT findings for both the small and large intestines included bowel wall thickness and enhancement, surrounding fat, distal arterial and venous mesenteric vessels, and lymph nodes.
The researchers then compared CT findings with clinical, lab, and pathological findings. Increased bowel wall mucosal enhancement and increased mesenteric vascularity were strong indicators of clinically active Crohn's disease. These indicators occurred in 88% of the cases.
Axial images were the most helpful in visualizing bowel wall thickening and assessment of mucosal enhancement, while 3D images allowed the researchers to best assess mesenteric vascularity status and length of bowel involvement. The water oral contrast agent enabled physicians to detect disease extending to a bowel anastomotic site in four patients.
Results are encouraging, but larger studies from multiple sites, pathologic correlative studies, and longitudinal follow-up studies remain to be done, Platt said. His department is currently reviewing more than 50 cases.
"We are already beginning to see at our hospital that MDCT could be an integral step for decision making regarding medical versus surgical therapy for Crohn's disease," he said.
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