CT Enteroclysis in the Diagnosis of Crohn's Disease (CD)

CT Enteroclysis in the Diagnosis of Crohn's Disease (CD) Poster No.: C-2291 Congress: ECR 2012 Type: Scientific Exhibit Authors: I. Kiss, A. Rosztóczy, F. Nagy, T. Wittmann, A. Palko; Szeged/HU Keywords: Abdomen, Gastrointestinal tract, Small bowel, CT, Diagnostic procedure, Localisation, Inflammation DOI: 10.1594/ecr2012/C-2291 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 21

Purpose Aim: to compare the radiomorphologic picture obtained by MDCT enterography to the endoscopic and histologic findings in patients with suspected Crohns disease. Methods and Materials Between 2007 and 2010, 319 patients [M/F 77/149, mean age 52,6 (15-83) years] with suspected CD were studied. During the study 1500-1800ml (prefusion rate of 100-130ml/ min) 0.5% methylcellulose was administered through a14fnasojejunal tube and a 64 slice CT scan was performed. Sagittal and coronal sections were reconstructed from the scans. The results were compared to the histological findings of the patients. Small intestine distension: 14 F naso-jejunal probe, 1400-2000 ml 0,5% metilcellulose solution (control- test scan) Flow: 110-130 ml/min Buscopan im, iv. (after 800-900 ml) - decreases or ceases the contraction of small intestine. Parameters of examination: collimation 3 mm, feed 5 mm, interval of reconstrucion 2 ill. 3 mm (cranio-caud.) 120 ml k. a., 3ml/s, 40s delay CT enteroclysis: Transmural spread Extraintestinal spread Assessment of mesenterium: Vascularisation Lymph nodes Fibro-fatty proliferation Page 2 of 21

Determination of abnormal changes of small intestines. Mural thickening of intestines: mucosal, minimal mural thickening. Stenoses (short stenosis - skip lesion) Detection of extraintestinal complications (abcess, fistula) Extension of the disease Detection of active inflammation Disadvantages: Low tissue contrast, Fine mucosa differences, aphthoid ulceration-detection of early signs is not possible Ionizing radiation Images for this section: Page 3 of 21

Fig. 1: small inestine enteroclysis (CT) negative Page 4 of 21

Results Fifty-five patients had radiomorphologic signs of CD, and all were confirmed by histology. Mild thickening (4-7mm) of the small intestinal wall was detected in 38, moderate (7-11mm) in 34 and severe (>11mm) in 11 patients. Mesenteric lymphnodes were observed in 42, increased vascular structure in 19 patients while fistula was seen in 1, skip leasion in 1. None of the patients had abscess. We also had 4 patients in whom the endoscopic evaluation did not confirmed the presence of CD. Specificity, sensitivity, positive and negative predictive values were 96,5%, 92,3%, 0,91 and 1.00 respectively. Images for this section: Page 5 of 21

Fig. 4: Crohn's disease - inflammation of terminal ileum with a severe (>11mm) wall thickening (young male patient) Page 6 of 21

Fig. 3: Crohn's disease - inflammation of terminal ileum with a moderate (7-11mm) wall thickening (young female patient) Page 7 of 21

Fig. 10: Crohn's disease - inflammation of the terminal ileum and ascending colon Page 8 of 21

Fig. 5: Skip laesion - saggital reconstruction Page 9 of 21

Fig. 11: Chrohn's disease - with the inflammation of the terminal ileum and ileum Page 10 of 21

Fig. 6: Crohn's disease. Skip laesion at the ileum Page 11 of 21

Fig. 9: Chrohn's disease. Coronal reconstruction of a skip laesion Page 12 of 21

Fig. 7: Crohn's disease, skip laesion (coronal reconstruction ) Page 13 of 21

Fig. 8: Crohn's disease.skip laesion. Dilatation of the jejunum and ileum Page 14 of 21

Fig. 13: Crohn's disease. Wall thickening of the ileum Page 15 of 21

Fig. 12: Mesenterial lymphadenoma. Crohn's disease Page 16 of 21

Fig. 2: Mild (4-7mm) wall thickening of the terminal ileum. Page 17 of 21

Fig. 15: Wall thickening of the terminal ileum. Page 18 of 21

Fig. 14: Tumor of the small intestine. Mesenterial lymphadenomegalia. Page 19 of 21

Conclusion Radiomorphologic results of CT enteroclysis were in accordance with the endoscopic / histologic diagnosis in patients with suspected CD. References Cesare H, Paola C, Angelo Z et al. Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn's disease. Int J Colorectal Dis 2003;18:121-5. Personal Information My specialty is gastroenterology since 1992. For instance oesophagus, gastric, and small bowel motility examination methods. I also initate and use these examination methods. I publicate my results on hungarian and international congresses. I use modern diagnostical methods - CT, MR, virtual colonoscopy - as professional as radiology. Educational background: Radiologist exam: 1987 degree number: 386/ 1987 Medical degree: 1982 SZOTE degree number: 91/1982. O. E. SZ I attended at the Royal College of Radiologists extension course 13-14 September 2000 Professional background: 2006- NEK Kft. Szeged - radiologist f#orvos (?) 2004- NEK Kft- Szeged - radiologist 2002-2004 SZOTE Clinic of Radiology, Clinic of I.Intestinal medicine head of departrment 1995-2002 II. Hospital Radology - assistant professor Page 20 of 21

1982-1995 SZOTE Radilogy Clinic - demonstrator Memberships: Magyar Orvosi Kamara Hungarian Society of Radiologists Hungarian Society of Gastroenterology Page 21 of 21