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- "Most of the extra intestinal complications are hepatic, including drug-induced hepatitis, gallstones in part due to vitamin B12 deficiency, hepatic abscesses, and sepsis-related hepatic sinusoidal dilata- tion. Fatty liver is the most common hepatobiliary complication of CD, resulting from chronic malnutrition, protein loss, and corticosteroid therapy.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - “Drug-induced hepatitis may result from iatrogenic hepatotoxic effects of thiopurines, methotrexate, sulfasalazine, cyclosporine, in- fliximab, adalimumab, and certolizumab used for treatment of CD. Generally, non-specific imaging features of hepatitis can be found, such as hepatomegaly, periportal edema, hepatic steatosis, and gallbladder wall thickening. The association of these findings with elevated results of liver function tests should raise concern in CD patients.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - "The incidence of urinary complications in patients with Crohn's disease has been reported to be 4%–23%, ranging from the most common simple cystitis to rarer advanced urinary sepsis. The most commonly encountered urinary disorders are urolithiasis and pyelonephritis.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - “Urolithiasis and pyelonephritis incidence ranges from 4% to 23% with a risk 10–100 times greater than the risk for the general population. Hydronephrosis may result from nephrolithiasis as a manifestation of CD, as the two disorders are associated in up to 12% of cases. The composition of kidney stones is usually based on calcium oxalate (resulting from hyperabsorption of oxalate) or uric acid (due to increased bicarbonate losses).”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - "Patients with CD have an increased risk of thromboembolic events, particularly venous embolism. These thromboembolic complications may be explained by many factors, such as common histories of abdominal surgery, corticosteroid use, and increased concentration of clotting factors in severe disease. The portal vein and its branches are the veins which are most affected by thrombosis. However, the superior or inferior mesenteric veins and the inferior vena cava may also be involved and detected on abdominopelvic CT or MRE.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - "In patients with Crohn's disease, women, almost exclusively premenopausal, may present with peritoneal inclusion cysts. These cysts develop as a result of adhesions and/or dysfunction of the peritoneum related to prior episodes of inflammation of prior surgeries. The fluid thus accumulates in the locules formed by the potential adhesions inside the peritoneum. Loculated fluid in the pelvis surrounding normal ovaries will be observed both by CT and MRE and should not be mistaken for pelvic cystic lesions, as it conforms to the peritoneal space.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - "The prevalence of ankylosing spondylitis (AS) in CD (1%–6%) is higher than in the general population (0.25%–1%). Axial manifestations of AS frequently precede the diagnosis of CD by several years. Sacroiliitis is the most obvious finding that may be depicted on CT or MRE, more often as an incidental finding showing long standing disease than acute inflammation. CT features initially include joint space irregularity, followed by classic erosion, sclerosis, and eventually ankyloses.”
Unusual intestinal and extra intestinal findings in Crohn's disease seen on T abdominal computed tomography and magnetic resonance enterography
Alida A et al.
Clinical Imaging 59 (2020) 30–38 - “Abdominal emergencies in cancer patients can result from the underlying malignancy itself, cancer therapy and/or result from the standard pathologies causing acute abdomen in otherwise healthy population. Therapy-related or disease-related immunosuppression or high dose analgesics often blunt many of the findings which are usually expected in non-cancer general population. This complicates the clinical picture rendering the clinical exam less reliable in many cancer patients, and resulting in different pathologies which clinicians and the radiologists should remain aware of.”
Imaging of acute abdomen in cancer patients
Morani AC et al.
Abdominal Radiology 2019 https://doi.org/10.1007/s00261-019-02332-5
- While the co-existence of segmental hyperenhancement and wall thickening are used in combination as imaging ndings re ecting Crohn’s disease inflammation, a number of other conditions can result in these imaging ndings even when segmental involvement is multifocal (42,43). Additionally, other imaging ndings often seen in small bowel Crohn’s disease in amimation, such as mural strati fication and intramural edema, can also be seen in a number of other conditions
- “While the co-existence of segmental hyperenhancement and wall thickening are used in combination as imaging findings re ecting Crohn’s disease inflammation, a number of other conditions can result in these imaging findings even when segmental involvement is multifocal.. Additionally, other imaging findings often seen in small bowel Crohn’s disease in animation, such as mural stratification and intramural edema, can also be seen in a number of other conditions.”
Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease David H. Bruining et al. Radiology 2018; 286:776–799 - “Mild inflammation is described when segmental hyperenhancement is present with minimal wall
thickening of 3−5 mm and rarely causes luminal narrowing. Severe inflammation is present if ulcerations or high T2 intramural signal are identified .”
Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease
David H. Bruining et al.
Radiology 2018; 286:776–799
“Because approximately one-quarter of Crohn’s disease patients present with an anorectal Fistula, complete imaging of the anal sphincters and perineum is imperative for every CTE and MRE examination.”
Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease David H. Bruining et al. Radiology 2018; 286:776–799 - “Structured reporting templates are used by many radiologic practices for speci c clinical scenarios to insure important clinical information is always captured in a systematic fashion. They have been shown to improve the quality of information conveyed to referring clinicians. Several groups have advocated for structured reporting for CTE and MRE. Table 7 demonstrates a structured cross-sectional enterography report and is adapted from Baker et al.”
Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease David H. Bruining et al. Radiology 2018; 286:776–799 - “The Lemann Index or Score was developed to describe the digestive disease location, severity, extent, and progression of Crohn’s disease as measured by imaging findings and reflected in surgical resections. It is a measure of the cumulative burden of digestive disease damage. The scale is based on the following 3 aspects: stricturing lesions, penetrating lesions, and the history of surgery or any other interventional pro- cedure. For each aspect, a grade is assigned from 0 to 3.”
Consensus Recommendations for Evaluation, Interpretation, and Utilization of Computed Tomography and Magnetic Resonance Enterography in Patients With Small Bowel Crohn’s Disease David H. Bruining et al. Radiology 2018; 286:776–799
- “In particular, CT enterography has proven to be effective in identifying involvement of the small and large bowel (including active inflammation, stigmata of chronic inflammation, and Crohn’s-related bowel neoplasia) by Crohn’s disease, as well as the extra-enteric manifestations of the disease, including fistulae, sinus tracts, abscesses, and urologic/hepatobiliary/osseous complications. Moreover, the proper use of 3-D technique (including volume rendering and maximum intensity projection) as a routine component of enterography interpretation can play a vital role in improving diagnostic accuracy.”
Computed tomography of Crohn’s disease: The role of three dimensional technique Siva P Raman,Karen M Horton,Elliot K Fishman World J Radiol. 2013 May 28; 5(5): 193–201 - “Crohn’s disease, a form of transmural inflammatory bowel disease affecting over 1.5 million Americans and Europeans, remains a difficult entity to diagnose clinically: While involvement of any segment of the gastrointestinal tract is possible, the disease most often affects the mesenteric small bowel, making direct endoscopic evaluation and biopsy difficult. Moreover, symptoms tend to be nonspecific, and there are no clinical symptoms or laboratory markers which allow a specific diagnosis.”
Computed tomography of Crohn’s disease: The role of three dimensional technique Siva P Raman,Karen M Horton,Elliot K Fishman World J Radiol. 2013 May 28; 5(5): 193–201 - “Crohn’s disease can involve any portion of the gastrointestinal tract from the mouth to the anus, although the small bowel is the most commonly affected portion of the bowel, particularly the distal and terminal ileum. The earliest phases of small bowel inflammation may be characterized only by subtle mucosal hyperenhancement on the arterial phase images, with little or no wall thickening or venous phase enhancement abnormalities. However, as the degree of inflammation progresses, thickening of the bowel wall is typically visualized (in addition to frank mucosal hyperemia on the venous phase images), with evidence of mural stratification (“target” or “double-halo appearance”). This mural stratification most often represents the juxtaposition of avidly enhancing mucosa with hypodense submucosal edema in the bowel wall itself, and in some cases, hyperemia of the serosal surface of the bowel.”
Computed tomography of Crohn’s disease: The role of three dimensional technique Siva P Raman,Karen M Horton,Elliot K Fishman World J Radiol. 2013 May 28; 5(5): 193–201 - “Crohn’s disease can involve any portion of the gastrointestinal tract from the mouth to the anus, although the small bowel is the most commonly affected portion of the bowel, particularly the distal and terminal ileum. The earliest phases of small bowel inflammation may be characterized only by subtle mucosal hyperenhancement on the arterial phase images, with little or no wall thickening or venous phase enhancement abnormalities. However, as the degree of inflammation progresses, thickening of the bowel wall is typically visualized (in addition to frank mucosal hyperemia on the venous phase images), with evidence of mural stratification (“target” or “double-halo appearance”).”
Computed tomography of Crohn’s disease: The role of three dimensional technique Siva P Raman,Karen M Horton,Elliot K Fishman World J Radiol. 2013 May 28; 5(5): 193–201 - “Patients with Crohn’s disease are at increased risk for both small bowel and colonic adenocarcinoma and lymphoma . Corresponding to the most common sites of inflammation in Crohn’s disease patients, the most common sites of small bowel adenocarcinoma are in the distal and terminal ileum, as opposed to the general population, where small bowel adenocarcinomas are most common in the duodenum. The overall risk of small bowel adenocarcinoma may be 15-50 times greater than in the general population, and are most commonly seen at the sites of greatest inflammation in each specific patient.”
Computed tomography of Crohn’s disease: The role of three dimensional technique Siva P Raman,Karen M Horton,Elliot K Fishman World J Radiol. 2013 May 28; 5(5): 193–201
- “Abscess formation is common in Crohn disease. In a large series from Mt Sinai, an abscess developed in 21% of patients with small bowel Crohn disease during the course of their disease. In a large series from Japan studying the cumulative incidence of abscess 10 and 20 years after disease onset, 9% and 25% of patients respectively developed an abscess as a complication of Crohn disease.”
Acute Infectious and Inflammatory Enterocolitides Baker ME Radiol Clin N Am 53 (2015) 1255–1271
- “Particularly in the evaluation of a postoperative patient, it may be helpful to utilize a standard CT protocol and positive water-soluble contrast to assess for extraluminal contrast signifying a leak. Such cases may be difficult to diagnose with neutral contrast.”
ACR Appropriateness Criteria Crohn Disease Kim DH et al. JACR Oct 2015 Vol 12, Issue 10, Pages 1048–1057 - “Compared with other imaging modalities, CT enterography/enteroclysis represents an optimal choice for most patients The diagnosis of acute inflammation is made through visualization of thickened small bowel with mural stratification, as well as extraenteric processes, including engorged vasa recti/vascular, and surrounding inflammatory stranding. Because CT enterography/enteroclysis is a cross-sectional imaging modality, assessment for alternative diagnoses, as well as for possible complications, including obstruction, abscess, and fistula, can be made.”
ACR Appropriateness Criteria Crohn Disease Kim DH et al. JACR Oct 2015 Vol 12, Issue 10, Pages 1048–1057 - “The issues of this clinical scenario can be addressed by CT enterography/enteroclysis. The sensitivity for Crohn Disease ranges from 75% to 90%, with a specificity of <90% against an endoscopic standard. As with MR, the same morphologic parameters can be used at CT to distinguish between active and fibrotic strictures. The superior spatial resolution and fast scanning abilities lead to consistent high-quality examinations.”
ACR Appropriateness Criteria Crohn Disease Kim DH et al. JACR Oct 2015 Vol 12, Issue 10, Pages 1048–1057 - “Cross-sectional (CT and MR) enterography is the preferred imaging test for the initial diagnosis, evaluation of acute flare, and surveillance of patients with suspected and known Crohn disease. For the initial examination in an adult patient with suspected Crohn disease, CT enterography is preferred, as it is much less bowel and respiratory motion dependent. With a severely ill or young patient, the ability to perform any of these examinations may be affected.”
ACR Appropriateness Criteria Crohn Disease Kim DH et al. JACR Oct 2015 Vol 12, Issue 10, Pages 1048–1057
- “CT enterography has proven to be effective in identifying involvement of the small and large bowel (including active inflammation, stigmata of chronic inflammation, and Crohn's-related bowel neoplasia) by Crohn's disease, as well as the extra-enteric manifestations of the disease, including fistulae, sinus tracts, abscesses, and urologic/hepatobiliary/osseous complications. Moreover, the proper use of 3-D technique (including volume rendering and maximum intensity projection) as a routine component of enterography interpretation can play a vital role in improving diagnostic accuracy.”
Computed tomography of Crohn's disease: The role of three dimensional technique.
Raman SP, Horton KM, Fishman EK
World J Radiol 2013 May 28;5(5):193-201 - “Crohn's disease, a transmural inflammatory bowel disease, remains a difficult entity to diagnose clinically. Over the last decade, multidetector computed tomography (CT) has become the method of choice for non-invasive evaluation of the small bowel, and has proved to be of significant value in the diagnosis of Crohn's disease. Advancements in CT enterography protocol design, three dimensional (3-D) post-processing software, and CT scanner technology have allowed increasing accuracy in diagnosis, and the acquisition of studies at a much lower radiation dose.”
Computed tomography of Crohn's disease: The role of three dimensional technique.
Raman SP, Horton KM, Fishman EK
World J Radiol 2013 May 28;5(5):193-201
- “In this referral population, the sensitivity of CT enterography for detecting small bowel bleeding
sources and small bowel masses was significantly greater than that of capsule endoscopy.”
Prospective Blinded Comparison of Wireless Capsule Endoscopy and Multiphase CT
Enterography in Obscure Gastrointestinal Bleeding
Huprich JE et al.
Radiology 2011; 260:744-751 - “Identification of a mass being clearly visible suggests strongly the presence of small bowel
adenocarcinoma in Crohn disease patients but adenocarcinoma may be completely
indistinguishable from benign fibrotic or acute inflammatory stricture. Knowledge of these
findings is critical to help suggest the diagnosis of this rare but severe complication of Crohn
disease.”
Small Bowel Adenocarcinoma in Crohn Disease:CT-enterography features with pathological
correlation
Soyer P, Hristova L, Boudghene F, Hoeffel C, Dray X, Laurent V, Fishman EK, Boudiaf M
Abdom Imaging 2011 Jun 14 (epub ahead of print) - “ CT enterographic findings of mural hyperenhancement, mural stratification, bowel wall
thickening, soft tissue stranding in the perienteric mesenteric fat, and engorged vasa recta
correlate with active mucosal and mural inflammation.”
CT Enterography as a Diagnostic Tool in Evaluation Small Bowel Disorders: Review of Clinical
Experience with over 700 Cases
Paulsen SR et al.
RadioGraphics 2006;26:641-662 - “ In two studies comparing CTE with ileoscopy , sensitivity was 92% and specificity 100% for the detection of stenosis.”
Gastroenterology Review and Perspective: the Role of Cross-Sectional Imaging in Evaluating Bowel Damage in Crohn Disease
Pariente B et al.
AJR 2011; 197:42-49 - “ CTE has shown more than 80% sensitivity and specificity for detecting small bowel segments affected by Crohn Disease because it allows multiplanar reformation with isovoxel resolution.”
Gastroenterology Review and Perspective: the Role of Cross-Sectional Imaging in Evaluating Bowel Damage in Crohn Disease
Pariente B et al.
AJR 2011; 197:42-49 - “ CT enterography (CTE) differs from routine abdominal CT in that CTE uses MDCT, multiplanar imaging, IV contrast material, and large volumes of neutral oral contrast agent to improve depiction of the small-bowel wall and lumen.”
Gastroenterology Review and Perspective: the Role of Cross-Sectional Imaging in Evaluating Bowel Damage in Crohn Disease
Pariente B et al.
AJR 2011; 197:42-49 - “ The European Crohn’s and Colitis Organization (ECCO) defined CTE as the imaging technique with the highest accuracy for the detection of intestinal involvement and assessment of inflammatory activity.”
Gastroenterology Review and Perspective: the Role of Cross-Sectional Imaging in Evaluating Bowel Damage in Crohn Disease
Pariente B et al.
AJR 2011; 197:42-49 Wireless Capsule Endoscopy
Conversely, in case of suspected mesenteric small bowel tumor, a negative wireless capsule examination has to be confirmed by the same imaging tests . This strongly questions the use of wireless capsule endoscopy in this indication and suggests that CT-enteroclysis, CT-enterography, MR-enteroclysis or MR-enterography should be the favored tests. However, wireless capsule endoscopy has recently benefited from marked technological improvements, which may work as a computer aid to diagnosis and help improve tumor detection .
Wireless Capsule Endoscopy
Wireless capsule endoscopy has now a well established role in the detection of mesenteric small bowel tumors. However, as experience accumulates, limitations of this techniques become more and more evident and recent reports suggest that the detection of small bowel tumors might not be the preferred indication. When a mesenteric small bowel tumor is suspected on wireless capsule endoscopy, it has to be further confirmed and characterized by CT or MR used in conjunction with enteroclysis or enterography.
"MR enterography and CT enterography have similar sensitivities for detecting active small bowel inflammation, but image quality across the study cohort was better with CT"
Prospective Comparison of State-of-the-Art MR Enterography and CT Enterography in Small Bowel Crohn’s Disease
Siddiki HA et al.
AJR 2009; 193:113-121"Compared with the standard dose examination, a 31-64% reduction in radiation dose was estimated for NI levels of 18-25, which corresponds to image noise of 19-27 HU in subcutaneous fat."
Low-Dose CT Examinations in Crohn’s Disease: Impact on Image Quality, Diagnostic Performance, and Radiation Dose
Kambadakone AR et al.
AJR 2010;195:78-88"Processed MDCT images with the introduction of noise to simulate low-dose MDCT examinations with Noise Index (NI) levels of 18-25 allows substantial dose reduction for CT examinations in Crohn’s disease without compromising diagnostic information."
Low-Dose CT Examinations in Crohn’s Disease: Impact on Image Quality, Diagnostic Performance, and Radiation Dose
Kambadakone AR et al.
AJR 2010;195:78-88"Despite a significant reduction in perceived image quality, diagnostic efficacy in detective active inflammatory Crohn’s disease of the terminal ileum was not significantly reduced by the dose reduction methods."
Effect of Altering Automatic Exposure Control Settings and Quality Reference mAs on Radiation Dose, Image Qualit, and Diagnostic Efficacy in MDCT Enterography of Active Inflammatory Crohn’s Disease
Allen BC et al.
AJR 2010; 195:89-100"Substantial dose reduction can be achieved using weight based quality reference mAs and altering AEC settings without affecting diagnostic efficacy in active inflammatory Crohn’s disease of the terminal ileum. However, subjective image quality can be compromised at these dose settings, depending on radiologist preference."
Effect of Altering Automatic Exposure Control Settings and Quality Reference mAs on Radiation Dose, Image Qualit, and Diagnostic Efficacy in MDCT Enterography of Active Inflammatory Crohn’s Disease
Allen BC et al. AJR 2010; 195:89-100"For 64-MDCT the CTDI vol decreased from 15.72 to 11.42 mGy and 11.42 to 9.25 mGy between original to intermediate and intermediate to final dose levels."
Effect of Altering Automatic Exposure Control Settings and Quality Reference mAs on Radiation Dose, Image Qualit, and Diagnostic Efficacy in MDCT Enterography of Active Inflammatory Crohn’s Disease
Allen BC et al.
AJR 2010; 195:89-100"Substantial dose reduction can be achieved using weight based quality reference mAs and altering AEC (automatic exposure control) settings without affecting diagnostic efficacy in active inflammatory Crohn’s disease of the terminal ileum."
Effect of Altering Automatic Exposure Control Settings and Quality Reference mAs on Radiation Dose, Image Quality, and Diagnostic Efficacy in MDCT Enterography of Active Inflammatory Crohn’s Disease
Allen BC et al.
AJR 2010; 195:89-100"In conclusion, this preliminary study is the first to our knowledge to show that imaging changes between sequential CT enterography examinations may be useful for monitoring Crohn’s disease progression or regression."
Using CT Enterography to Monitor Crohn’s Disease Activity: A Preliminary Study
Hara AK et al.
AJR 2008; 190:1512-1516"This preliminary study indicates that imaging changes between CT enterography examinations have excellent potential for reliably monitoring Crohn’s disease progression or regression."
Using CT Enterography to Monitor Crohn’s Disease Activity: A Preliminary Study
Hara AK et al.
AJR 2008; 190:1512-1516"Currently CT is the initial imaging technique of choice in suspected Crohn’s disease complications for both adults and children. In one large study of 80 patients, CT detected unsuspected findings that led to changes of medical or surgical management in 28% of patients."
ACR Appropriateness Criteria on Crohn’s Disease
Huprich JE et al.
J Am Coll Radiol 2010;7:94-102- Adult; Crohn’s Disease and mild symptoms
Radiologic Procedure
Rating (9 most appropriate, 1 least appropriate)
CT Abd/Pelvis (enterography)
9 MRI Abd/Pel (MR enterography)
8 X-ray SBFT
7 CT Abd/Pelvis (routine)
6 X-ray contrast enema
5 X-ray abdomen
5
Ultrasound Abdomen/Pelvis
4 Ultrasound pelvis endorectal
2 99m-Tc HMPAO leukoscintigraphy
2 - Adult; Crohn’s Disease and fever, increasing pain
Radiologic Procedure
Rating (9 most appropriate, 1 least appropriate)
CT Abd/Pelvis (routine)
9 CTAbd/Pelvis (enterography)
7 MRI Abd/Pel (MR enterography)
7 X-ray abdomen
5 Ultrasound Abdomen/Pelvis
5 X-ray contrast enema
5
X-ray SBFT
5 Ultrasound pelvis endorectal
4 99m-Tc HMPAO leukoscintigraphy
3 - Adult; Initial presentation- Crohn’s Disease Suspected
Radiologic Procedure
Rating (9 most appropriate, 1 least appropriate)
CT Abd/Pelvis (CT enterography)
9 X-ray SBFT
7 CT Abd/Pelvis (routine)
6 X-ray contrast enema
6 MRI Abd/Pel (MR enterography)
6 X-ray Abdomen
5 (r/o free air)
Ultrasound Abd/Pelvis
5 Ultrasound pelvis endorectal
3 99m-Tc HMPAO leukoscintigraphy
3 - CT Enterography: Crohn’s Disease
Oral contrast
- 1000 cc of water given over a 15-20 minute period
- 900 cc of Volumen given over 20 minutes (450 cc/10 minutes) followed by 450 of water and scan the patient at 30 minutes post start of oral contrastIV contrast
- 80-120 cc of non-ionic contrast ( usually at 320-350 concentration like iohexol-350 or iodixanol-320) - Patient preparation
Oral contrast
- 1000 cc of water given over a 15-20 minute period
- 1000 cc of positive contrast (oral Omnipaque) given over 45-60 minutesIV contrast
- 80-120 cc of non-ionic contrast ( usually at 320-350 concentration like iohexol-350 or iodixanol-320) - Imaging Crohn’s Disease: Options
- CT enterography
- X-ray small bowel follow thru
- CT abdomen (routine) X-ray contrast enema
- MRI abdomen (MR enterography)
- Ultrasound
- 99m-Tc HMPAO leukoscintigraphy "Therefore it is no longer sufficient for radiologists to only detect the presence of Crohn’s disease; they must also accurately assess its subtype,location and severity."
ACR Appropriateness Criteria on Crohn’s Disease
Huprich JE et al.
J Am Coll Radiol 2010;7:94-102- Extraintestinal manifestations
- Arthritis
- Cholelithiasis
- Dermatologic disorders
- Ocular manifestations - Bowel findings include
- Transmural granulomatous inflammation
- Deep ulcers that may progress to sinus tract or fistulae
- Strictures that may lead to obstruction
- Skip lesions are common - Crohns Disease: Facts
- Small bowel affected alone in about one third of patients
- Colon is affected alone in 20-30% of patients
- Combined involvement of the small bowel and colon occurs in 40-50% of patients "This article discuses the usefullness of both traditional and newer imaging techniques in the management of Crohn’s disease and its various clinical presentations."
ACR Appropriateness Criteria on Crohn’s Disease
Huprich JE et al.
J Am Coll Radiol 2010;7:94-102"In the diagnosis of anastomotic recurrence, severe anastomotic stenosis was 95% sensitive, both comb sign and stratification were 95% specific, and stratification was 92% accurate."
Suspected Anastomotic Recurrence of Crohn Disease after Ileocolic Resection: Evaluation with CT Enteroclysis
Soyer P et al.
Radiology 2010; 254:755-764" CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and fibrostenosis at the anastomotic site after ileocolic resection for Crohn disease."
Suspected Anastomotic Recurrence of Crohn Disease after Ileocolic Resection: Evaluation with CT Enteroclysis
Soyer P et al.
Radiology 2010; 254:755-764