Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn's disease

Abstract

Objective. In patients, with symptomatic Crohn's disease (CD), valid information about the presence or absence of small bowel disease activity and stenosis is clinically important. Such information supports decisions about medical or surgical therapy and can be obtained with MR enterography (MRE) or CT enterography (CTE). Materials and methods. A total of 50 patients with symptomatic pre-existing CD and a demand for small bowel imaging to support changes in treatment strategy were included in this prospective and blinded study. MRE and CTE were performed on the same day in alternating order and subsequently compared with the gold standard: pre-defined lesions at ileoscopy (n = 30) or surgery with (n = 12) or without (n = 3) intra-operative enteroscopy. Results. A total of 35 patients had active small bowel CD (jejunum 0, ileum 1, (neo)-terminal ileum 34) and 20 had small bowel stenosis. The sensitivity and specificity of MRE for detection of small bowel CD was 74% and 80% compared to 83% and 70% with CTE (p ≥ 0.5). MRE and CTE detected small bowel stenosis with 55% and 70% sensitivities, respectively (p = 0.3) and 92% specificities. Conclusions. MRE and CTE have comparable diagnostic accuracies for detection of small bowel CD and stenosis. In symptomatic patients with CD and high disease prevalence, positive predictive values are favorable but negative predictive values are low. Consequently, MRE and CTE can be relied upon, if a positive result is obtained whereas a negative enterography should be interpreted with caution.

Key Words::

• autoimmune diseases
• clinical trial
• radiology
• intestine

Acknowledgments

Many thanks to the following colleagues for participation in this study: Troels Havelund, Benedicte Wilson, Jane Møller Hansen, Laurits Laursen, Finn Møller Pedersen, Ove B. Schaffalitzky de Muckadell, and Karsten Lauritsen, Department of Gastroenterology, Odense University Hospital, Denmark; Anette Hygum Knudsen, Ejler Ejlersen, Bent Nyboe Andersen, and Henrik Hey, Department of Internal Medicine, Lillebaelt Hospital Vejle, Denmark; Torben Knudsen, Thøger Thøgersen, and Ulrich-Martin Bich, Department of Internal Medicine, Hospital of South West Denmark, Denmark; Claus Aalykke and Axel Malchow-Møller, Department of Internal Medicine, Hospital of Funen Svendborg, Denmark; Tina Elisabeth Ormstrup, Chris Vagn-Hansen, Lone østergaard, Torben Sørensen, and Head nurse Else Ipsen, Department of Radiology, Lillebaelt Hospital Vejle, Denmark; Jens Christian Riis Jørgensen, Flemming Bech-Knudsen, Vagn Berg, and Bodil Majgaard, Department of Abdominal Surgery, Lillebaelt Hospital Vejle, Denmark.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.