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Is it Crohn's disease or intestinal tuberculosis? CT analysis
1Department of Radiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
European Journal of Radiology
|August 26, 1998
Summary
Computed tomography (CT) effectively differentiates intestinal tuberculosis (IT) from Crohn's disease (CD) when barium studies are inconclusive. CT identified key differences in bowel wall and mesenteric features, aiding definitive radiological diagnosis.
Area of Science:
- Radiology
- Gastroenterology
- Infectious Diseases
Background:
- Distinguishing intestinal tuberculosis (IT) from Crohn's disease (CD) is challenging with conventional barium studies.
- Accurate radiological diagnosis is crucial for appropriate patient management.
Purpose of the Study:
- To identify distinguishing bowel wall and mesenteric features on computed tomographic (CT) scans to differentiate IT from CD.
- To evaluate the diagnostic accuracy of CT in cases where barium studies were indeterminate.
Main Methods:
- Retrospective analysis of CT scans in 36 patients with differential diagnosis of IT or CD.
- Comparison of CT findings with final diagnoses (tuberculosis, CD, carcinoid, appendicitis, bowel infarction).
Main Results:
- CT demonstrated varied bowel wall changes in IT (e.g., asymmetric thickening, exophytic mass) and concentric thickening in CD.
- Mural stratification (target sign) was absent in IT but present in about half of CD cases.
- Lymphadenopathy characteristics differed: larger nodes with necrotic centers in IT, fibrofatty changes causing displacement in CD.
- CT achieved an 81% diagnostic accuracy (26/32 cases) for indeterminate barium studies.
Conclusions:
- CT provides valuable distinguishing features for differentiating IT and CD, including bowel wall morphology and lymphadenopathy patterns.
- CT is recommended when barium gastrointestinal studies fail to provide a definitive diagnosis between IT and CD.