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P288. CT enterography is useful in differentiating Crohn's disease from intestinal tuberculosis

R. Mao1, P.-j. Hu1, M.-h. Chen1, 1The First Affiliated Hospital of Sun Yat-sen University, Gastroenterology, Guangzhou, China

Background

Intestinal tuberculosis (ITB) and Crohn's disease (CD) are chronic inflammatory bowel disorders that are difficult to differentiate from one another. The problem is of greatest interest in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. This study aimed to evaluate the diagnostic value of CT enterography (CTE) findings in the differential diagnosis between ITB and CD.

Methods

From June 2011 to June 2012, 105 consecutive patients with a final diagnosis of CD (n = 67) or ITB (n = 38) who underwent CTE were prospectively enrolled in the study. The diagnosis of CD was established on the basis of the European Crohn's and Colitis Organization guidelines, i.e., a combination of clinical endoscopic and histological features. The diagnosis of ITB was based on endoscopic response to anti-tuberculosis treatment. The CTE findings were reviewed by two radiologists who were blind to patient histories, endoscopic findings and final diagnosis. In CTE, bowel involvement (proximal small bowel involvement, segmental involvement and focal ileocecal lesions), mural change (mural thickening, stratification, comb sign, mesenteric fat stranding, mesenteric fibrofatty proliferation), Mesentery lymph node central hypoattenuating or calcification and complication (stenosis, abscess or fistula) were assessed.

Results

The male-to-female ratio was 43:24 in patients with CD and 20:18 in patients with ITB (p > 0.05). Proximal small bowel lesions, asymmetrical mural thickening, segmental small bowel lesions, mural stratification, comb sign and mesentery fibrofatty proliferation were significantly more common in patients with CD than in patients with ITB 29.9% vs. 5.3%, p < 0.001; 56.7% vs. 5.3%, p < 0.001; 83.6% vs. 15.8%, p < 0.001; 80.6% vs. 7.9%, p < 0.001; 79.1% vs. 7.9%, p < 0.001; 37.3% vs. 0%, p < 0.001), whereas mesenteric lymph node change (calcification or necrosis) and focal ileocecal lesions were more frequently observed in ITB (28.9% vs. 0%, p < 0.001; 55.3% vs. 7.5%, p < 0.001). On multivariate analysis, Segmental small bowel lesions (OR 0.104[CI0.022–0.50]) and mural stratification OR 0.028[CI0.003–0.26] were independent predictors of CD. The sensitivity, specificity and AUC were 83.6%, 84.2%, 0.839 and 80.6%, 92.1%, 0.864, respectively.

Conclusion

CT Enterography is useful in Differentiating Crohn's Disease from Intestinal Tuberculosis.