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Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower
Sunyoung Lee1, Byong Duk Ye2, Seong Ho Park1
1Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea.
Insights
Contrast-enhanced CT has a low diagnostic yield for acute severe lower gastrointestinal bleeding in Crohn's disease patients. However, CT enterography can help predict rebleeding risk, guiding further management.
Area of Science:
- Gastroenterology
- Radiology
- Medical Imaging
Background:
- Crohn's disease (CD) patients frequently present with acute severe lower gastrointestinal bleeding (LGIB).
- Contrast-enhanced computed tomography (CT) is utilized to diagnose the source of bleeding.
- The diagnostic yield and rebleeding risk prediction capabilities of CT in this context require further investigation.
Purpose of the Study:
- To evaluate the diagnostic yield of contrast-enhanced CT for identifying active bleeding in CD patients with acute severe LGIB.
- To assess the role of CT in predicting the risk of rebleeding in these patients.
Main Methods:
- Retrospective analysis of 110 CD patients with acute severe LGIB from 2005-2016.
- 86 patients underwent contrast-enhanced CT; diagnostic yield for contrast extravasation was calculated.
- Cox regression analysis was used to identify predictors of rebleeding in 62 patients who had negative CT enterography (CTE) results.
Main Results:
- The overall diagnostic yield of CT for detecting contrast extravasation was 10.5%.
- No significant difference in yield was observed between single-phase and multiphase CT, or between non-enterographic CT and CTE.
- Extensive CD and a higher bowel wall-to-artery enhancement ratio were associated with increased rebleeding risk, while anti-TNF-α therapy reduced this risk.
Conclusions:
- Contrast-enhanced CT has a limited diagnostic yield for acute severe LGIB in CD patients.
- Negative CTE findings can still be valuable for predicting the risk of subsequent rebleeding.
- CT parameters and treatment strategies influence rebleeding risk in CD patients with LGIB.
Objective:
To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding.
Materials And Methods:
A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis.
Results:
The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041).
Conclusion:
The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.