Crohn disease: Mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation

Kale D. Bodily, Joel Garland Fletcher, Craig A. Solem, C. Daniel Johnson, Jeff L. Fidler, John M. Barlow, Michael R. Bruesewitz, Cynthia H McCollough, William J. Sandborn, Edward Vincent Loftus, Jr, William S. Harmsen, Brian S. Crownhart

Research output: Contribution to journalArticle

254 Citations (Scopus)

Abstract

Purpose: To determine retrospectively if quantitative measures of small-bowel mural attenuation and thickness at computed tomographic (CT) enterography correlate with endoscopic and histologic findings of small-bowel inflammation and to estimate the performance of these measures in predicting inflammatory Crohn disease. Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study, which was conducted with patient informed consent. CT enterography data in 96 patients (31 male patients and 65 female patients) who underwent, ileoscopy with or without biopsy were examined for CT signs of active Crohn disease. The most highly enhancing segment of terminal ileum and a normal-appearing ileal loop were identified. After it was confirmed that semiautomated software could accurately measure mural attenuation and thickness, the selected terminal ileal and normal-appearing (control) ileal loops were examinated (20 automated measurements at each location) to quantify mural attenuation and wall thickness. Results were compared with endoscopy and histology reports by using logistic regression analysis and receiver operating characteristic curves. Results: Quantitative measures of terminal ileal mural attenuation and wall thickness correlated significantly with active Crohn disease (P < .001). Small-bowel wall thickness was not a significant factor after attenuation was taken into account. A threshold attenuation value with a sensitivity of 90% (18 of 20) for definite Crohn disease (compared with a sensitivity of 80% [16 of 20] for radiologist assessment) was selected. In patients who underwent ileal biopsy, threshold attenuation had a sensitivity identical to that of ileoscopy (81% [26 of 32]; 95% confidence interval: 64%, 93%) in predicting histologic inflammation. Conclusion: Quantitative measures of mural attenuation and wall thickness at CT enterography correlate highly with ileoscopic and histologic findings of inflammatory Crohn disease. Quantitative measures of mural attenuation are sensitive markers of small bowel inflammation.

Original languageEnglish (US)
Pages (from-to)505-516
Number of pages12
JournalRadiology
Volume238
Issue number2
DOIs
StatePublished - Feb 2006

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Crohn Disease
Inflammation
Health Insurance Portability and Accountability Act
Biopsy
Research Ethics Committees
Informed Consent
Ileum
ROC Curve
Endoscopy
Histology
Software
Retrospective Studies
Logistic Models
Regression Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

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Crohn disease : Mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation. / Bodily, Kale D.; Fletcher, Joel Garland; Solem, Craig A.; Johnson, C. Daniel; Fidler, Jeff L.; Barlow, John M.; Bruesewitz, Michael R.; McCollough, Cynthia H; Sandborn, William J.; Loftus, Jr, Edward Vincent; Harmsen, William S.; Crownhart, Brian S.

In: Radiology, Vol. 238, No. 2, 02.2006, p. 505-516.

Research output: Contribution to journalArticle

Bodily, Kale D. ; Fletcher, Joel Garland ; Solem, Craig A. ; Johnson, C. Daniel ; Fidler, Jeff L. ; Barlow, John M. ; Bruesewitz, Michael R. ; McCollough, Cynthia H ; Sandborn, William J. ; Loftus, Jr, Edward Vincent ; Harmsen, William S. ; Crownhart, Brian S. / Crohn disease : Mural attenuation and thickness at contrast-enhanced CT enterography-correlation with endoscopic and histologic findings of inflammation. In: Radiology. 2006 ; Vol. 238, No. 2. pp. 505-516.
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abstract = "Purpose: To determine retrospectively if quantitative measures of small-bowel mural attenuation and thickness at computed tomographic (CT) enterography correlate with endoscopic and histologic findings of small-bowel inflammation and to estimate the performance of these measures in predicting inflammatory Crohn disease. Materials and Methods: The institutional review board approved this HIPAA-compliant retrospective study, which was conducted with patient informed consent. CT enterography data in 96 patients (31 male patients and 65 female patients) who underwent, ileoscopy with or without biopsy were examined for CT signs of active Crohn disease. The most highly enhancing segment of terminal ileum and a normal-appearing ileal loop were identified. After it was confirmed that semiautomated software could accurately measure mural attenuation and thickness, the selected terminal ileal and normal-appearing (control) ileal loops were examinated (20 automated measurements at each location) to quantify mural attenuation and wall thickness. Results were compared with endoscopy and histology reports by using logistic regression analysis and receiver operating characteristic curves. Results: Quantitative measures of terminal ileal mural attenuation and wall thickness correlated significantly with active Crohn disease (P < .001). Small-bowel wall thickness was not a significant factor after attenuation was taken into account. A threshold attenuation value with a sensitivity of 90{\%} (18 of 20) for definite Crohn disease (compared with a sensitivity of 80{\%} [16 of 20] for radiologist assessment) was selected. In patients who underwent ileal biopsy, threshold attenuation had a sensitivity identical to that of ileoscopy (81{\%} [26 of 32]; 95{\%} confidence interval: 64{\%}, 93{\%}) in predicting histologic inflammation. Conclusion: Quantitative measures of mural attenuation and wall thickness at CT enterography correlate highly with ileoscopic and histologic findings of inflammatory Crohn disease. Quantitative measures of mural attenuation are sensitive markers of small bowel inflammation.",
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AU - Fletcher, Joel Garland

AU - Solem, Craig A.

AU - Johnson, C. Daniel

AU - Fidler, Jeff L.

AU - Barlow, John M.

AU - Bruesewitz, Michael R.

AU - McCollough, Cynthia H

AU - Sandborn, William J.

AU - Loftus, Jr, Edward Vincent

AU - Harmsen, William S.

AU - Crownhart, Brian S.

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