Computed Tomography Enterography Detects Intestinal Wall Changes and Effects of Treatment in Patients With Crohn's Disease

David H Bruining, Edward Vincent Loftus, Jr, Eric Ehman, Hassan A. Siddiki, Douglas L. Nguyen, Jeff L. Fidler, James E. Huprich, Jayawant Mandrekar, William S. Harmsen, William J. Sandborn, Joel Garland Fletcher

Research output: Contribution to journalArticle

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Abstract

Background & Aims: The use of computed tomography enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods: We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215-630). Results: Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions: Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.

Original languageEnglish (US)
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number8
DOIs
StatePublished - Aug 2011

Fingerprint

Crohn Disease
Tomography
Therapeutics
Biomarkers
Serum
C-Reactive Protein
Retrospective Studies
Inflammation
Infliximab

Keywords

  • IBD
  • Imaging
  • Inflammatory Bowel Disease
  • Intestinal Wall Changes

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Computed Tomography Enterography Detects Intestinal Wall Changes and Effects of Treatment in Patients With Crohn's Disease. / Bruining, David H; Loftus, Jr, Edward Vincent; Ehman, Eric; Siddiki, Hassan A.; Nguyen, Douglas L.; Fidler, Jeff L.; Huprich, James E.; Mandrekar, Jayawant; Harmsen, William S.; Sandborn, William J.; Fletcher, Joel Garland.

In: Clinical Gastroenterology and Hepatology, Vol. 9, No. 8, 08.2011.

Research output: Contribution to journalArticle

Bruining, David H ; Loftus, Jr, Edward Vincent ; Ehman, Eric ; Siddiki, Hassan A. ; Nguyen, Douglas L. ; Fidler, Jeff L. ; Huprich, James E. ; Mandrekar, Jayawant ; Harmsen, William S. ; Sandborn, William J. ; Fletcher, Joel Garland. / Computed Tomography Enterography Detects Intestinal Wall Changes and Effects of Treatment in Patients With Crohn's Disease. In: Clinical Gastroenterology and Hepatology. 2011 ; Vol. 9, No. 8.
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abstract = "Background & Aims: The use of computed tomography enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods: We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47{\%} female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215-630). Results: Of 105 lesions, 52 (49.5{\%}) improved, 11 (10.5{\%}) remained unchanged, and 42 (40.0{\%}) worsened. Per patient, 28 (44.4{\%}) were responders, 12 (19.0{\%}) were partial responders, and 23 (36.5{\%}) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions: Radiologic improvement was observed in 63.4{\%} of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.",
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AU - Loftus, Jr, Edward Vincent

AU - Ehman, Eric

AU - Siddiki, Hassan A.

AU - Nguyen, Douglas L.

AU - Fidler, Jeff L.

AU - Huprich, James E.

AU - Mandrekar, Jayawant

AU - Harmsen, William S.

AU - Sandborn, William J.

AU - Fletcher, Joel Garland

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AB - Background & Aims: The use of computed tomography enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance. Methods: We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215-630). Results: Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively). Conclusions: Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.

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