P287. CT enterography remains a valuable tool for the assessment of Crohn's disease
K.L. White1, C.A. Boyd1, M. Sapundzieski2, J.K. Limdi1, 1Pennine Acute Hospitals, Gastroenterology, Manchester, United Kingdom, 2Pennine Acute Hospitals, Radiology, Manchester, United Kingdom
Advances in the immunopathogenesis of inflammatory bowel disease (IBD) coupled with bolder definitions of disease control have led to increasing reliance on imaging to characterize inflammation beyond the reach of the endoscope. Clinical activity indices underestimate biologic activity and cannot detect transmural disease. We aimed to assess the role of CT enterography (CTE) in assessing Crohn's disease (CD).
A retrospective review of 390 consecutive CTE studies was performed between January 2009 and November 2012 at our institution. Clinical data including demographics, disease characteristics and therapy were obtained from electronic patient record review. Inflammatory markers, radiological investigations and ileocolonoscopy when performed within 90 days of CTE were recorded. CTE reports were recorded using accepted activity criteria – small bowel dilatation, stenosis, wall thickening, enhancement, mucosal irregularity, mesenteric inflammation, hypervascularity, lymph node enlargement, abscesses, fistulation and extraintestinal features.
Of 168 patients with IBD at time of CTE, 148 had CD. Eighty-nine of 148 patients were female, mean age 52 (range 16–87) and median term of follow up of 5 years (range 0–35).
Abnormalities were noted in 95 scans; 53 had active non-stricturing, 40 active stricturing and 2 fibrostenotic disease. Within active groups, there were 10 fistulae and 3 abscesses in 11 patients. Ileo-colonoscopy was performed in 41 patients with 27 showing active inflammation and raised CRP in 36/92. Treatment was increased in 55% of the active non-stricturing group, 6/29 to azathioprine, 4/29 to biologics, 4/29 to methotrexate, 7/29 to steroids, 5/29 to surgery with no change in the remaining 45%, of whom 8/12 had inactive disease at ileo-colonoscopy and 15/22 normal CRP.
In 60% of active stricturing patient treatment was increased in 1 to azathioprine, 11 to biologics, 5 to surgery. Eleven of 24 patients in this group had an elevated CRP and 10/12 had active colitis at ileo-colonoscopy.
Of 52 normal CTE, treatment was escalated in 3 to methotrexate or azathioprine with colitis at colonoscopy and unchanged in 92%.
Concerns regarding potential cumulative effects of ionizing radiation are valid but likely to be offset by changing technology and reduction in average doses of radiation.
CTE has a role in well-selected patients with CD (e.g. age >50, very sick patients) identifying active disease and influencing meaningful therapeutic decisions.