Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn's disease

Abstract

Background and aims: Enteroclysis and computed tomography (CT) have been recently combined in to assess small bowel alterations. We compared the accuracy of CT enteroclysis to that of endoscopy in detecting bowel wall alterations of the terminal or neoterminal ileum in Crohn's disease (CD) patients and assessed whether postcontrast wall density is related to clinical activity of CD.

Patients and methods: A total of 39 patients referred for either established or suspected CD were enrolled. Diagnosis used ileocolonoscopy with histology; clinical activity was measured by CDAI. Contrast-enhanced spiral CT of the abdomen was performed after distension of the small bowel with an enema of methylcellulose. Retrograde ileocolonoscopy diagnosed 30 patients with CD of the ileum, while 9 patients served as controls.

Results: CT enteroclysis detected CD in 26 patients (86.7%) and in none of the control group. Three of four patients with false-negative findings on CT enteroclysis had postsurgical CD recurrence. The overall sensitivity and specificity of CT enteroclysis for ileal CD detection were 86.7% and 100%, respectively (PPV=100%; NPV=69.2%), and 94.1% and 100% (PPV=100%; NPV=90%), excluding those patients with postsurgical recurrence. The postcontrast wall density was significantly higher in CD patients than in the controls and was significantly correlated with the severity of CD.

Conclusion: CT enteroclysis proved highly accurate in detecting terminal ileal CD involvement, particularly in patients without previous surgery, and to allow assessment of the degree of intramural and clinical activity.