Abnormal findings on abdominopelvic cross-sectional imaging in patients with microscopic colitis: a retrospective, multicenter study

Abstract

Objectives

Patients with microscopic colitis may have subtle macroscopic findings on colonoscopy such as erythema, edema, or altered vascular pattern; however, radiographic abnormalities on cross-sectional imaging have not been investigated. We aimed at identifying the abdominopelvic radiographic abnormalities in patients with microscopic colitis, as well as possible correlation with endoscopic findings and the need for extended duration of treatment.

Materials and Methods

This was a retrospective study of patients with biopsy-proven microscopic colitis at two tertiary centers between 1 January 2010 and 30 April 2020. Patients underwent computed tomography scan or magnetic resonance imaging within 30 days of a diagnostic flexible sigmoidoscopy or colonoscopy. Patients with colon ischemia and other causes of colitis were excluded. Radiographic abnormalities from imaging reports included bowel wall thickening, mucosal hyperenhancement and mesenteric fat stranding. Univariate and multivariable logistic regression models were used to identify predictors of radiographic abnormalities.

Results

498 patients with microscopic colitis underwent abdominopelvic cross-sectional imaging within 30 days of flexible sigmoidoscopy/colonoscopy. Lymphocytic colitis was diagnosed in 54.6% of patients, and collagenous colitis in 45.4%. Endoscopic and radiographic abnormalities were identified in 16.1% and 12.4% of patients, respectively. Radiographic abnormalities were associated with the need for budesonide therapy (p = .029) and budesonide therapy long-term (p = .0028). Budesonide therapy long-term (p = .047) was associated with radiographic abnormalities in multivariate analysis.

Conclusions

Radiographic abnormalities may be present on abdominopelvic cross-sectional imaging in a minority of patients with biopsy-proven microscopic colitis, suggesting cross-sectional imaging has low clinical value in the evaluation and treatment of this disease.

Keywords:

• microscopic colitis
• endoscopy
• colonoscopy
• diagnostic imaging
• lymphocytic colitis
• collagenous colitis

Acknowledgements

The authors acknowledge Dr. Murli Krishna for his contributions to data acquisition.

Author contributions

Andree H. Koop- the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be submitted. Ahmed Salih- acquisition of data, revising the article critically for important intellectual content, final approval of the version to be submitted. Mohamed Omer- acquisition of data, revising the article critically for important intellectual content, final approval of the version to be submitted. Josh Kwon- acquisition of data, revising the article critically for important intellectual content, final approval of the version to be submitted. Hassan M. Ghoz- acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be submitted. Matthew McCann- acquisition of data, revising the article critically for important intellectual content, final approval of the version to be submitted. June Tome- acquisition of data, revising the article critically for important intellectual content, final approval of the version to be submitted. William C. Palmer- the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, final approval of the version to be submitted. Darrell S. Pardi- the conception and design of the study, acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content, final approval of the version to be submitted. Fernando F. Stancampiano- the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, final approval of the version to be submitted.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

No financial support was received for this study. Part of this work was presented as a poster presentation virtually at Disease Week May 2021.