Clinical correlations of small bowel CT and contrast radiology findings in Crohn's disease

Backgrounds and Objective: Aim of the present study was to evaluate the clinical correlates of small bowel CT patterns in patients with Crohn's disease (CD), as com- pared to barium studies and endoscopic find- ings, as far as parameters of disease activity are concerned. Material and Methods: Thirty five patients with pathologically proven CD were studied by means of helical single detector CT (13) or multi- detector CT (22), after administration of low den- sity contrast by mouth (13) or by nasojeunal tube (22). Eight hours later, all patients were studied with barium administered by mouth (13) or with barium and methilcellulose administered by nasojeunal tube (22). Clinical activity was as- sessed by CDAI score, ESR, CRP, alpha1 glyco- protein and fibrinogen levels. In twenty one pa- tients, colonoscopy was also performed. Results: Sensitivity of small bowel CT ver- sus endoscopy was of 88% while sensitivity of barium studies was of 77% versus endoscopic findings, and it reached 100% for the combina- tion of both exams. We found positive correla- tions between the detection at CT of "target sign" and a CDAI score > 150 or abnormal val- ues of CRP, ESR, α 1glycoprotein. Abnormal ESR or fibrinogen levels were correlated with the detection of fistulas at CT scans. The diam- eter of enlarged mesenteric lymph nodes was correlated with α 1glycoprotein values. No simi- lar correlations were detected for contrast ra- diology findings. Discussion: This study underscores the clini- cal usefulness of performing small bowel CT in adjunct to conventional diagnostic studies in Crohn's disease patients. CT findings (either by oral route or nasojeunal tube) correlate with pa- rameters of disease activity.