TY - JOUR
T1 - Computed Tomography Enterography Detects Intestinal Wall Changes and Effects of Treatment in Patients With Crohn's Disease
AU - Bruining, David H.
AU - Loftus, Edward V.
AU - Ehman, Eric C.
AU - Siddiki, Hassan A.
AU - Nguyen, Douglas L.
AU - Fidler, Jeff L.
AU - Huprich, James E.
AU - Mandrekar, Jayawant N.
AU - Harmsen, William S.
AU - Sandborn, William J.
AU - Fletcher, Joel G.
N1 - Funding Information:
Funding This report was supported by an investigator-initiated grant from Centocor Ortho Biotech .
PY - 2011/8
Y1 - 2011/8
N2 - 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.
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.
KW - IBD
KW - Imaging
KW - Inflammatory Bowel Disease
KW - Intestinal Wall Changes
UR - http://www.scopus.com/inward/record.url?scp=79960554386&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960554386&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2011.04.025
DO - 10.1016/j.cgh.2011.04.025
M3 - Article
C2 - 21621641
AN - SCOPUS:79960554386
SN - 1542-3565
VL - 9
SP - 679-683.e1
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 8
ER -