Presented in part at the Annual Meeting of the American Gastroenterological Association, San Diego, California, May 17–22, 2009 (Gastroenterology 2008;134(4 Suppl 1):A202).
Article first published online: 17 FEB 2011
Copyright © 2011 Crohn's & Colitis Foundation of America, Inc.
Inflammatory Bowel Diseases
Volume 18, Issue 2, pages 219–225, February 2012
How to Cite
Bruining, D. H., Siddiki, H. A., Fletcher, J. G., Sandborn, W. J., Fidler, J. L., Huprich, J. E., Mandrekar, J. N., Harmsen, W. S., Evans, P. E., Faubion, W. A., Hanson, K. A., Ingle, S. B., Pardi, D. S., Schroeder, K. W., Tremaine, W. J. and Loftus, E. V. (2012), Benefit of computed tomography enterography in Crohn's disease: Effects on patient management and physician level of confidence. Inflamm Bowel Dis, 18: 219–225. doi: 10.1002/ibd.21683
Supported in part by a grant from the American College of Gastroenterology and the Mayo Foundation for Medical Education and Research.
- Issue published online: 10 JAN 2012
- Article first published online: 17 FEB 2011
- Manuscript Accepted: 18 JAN 2011
- Manuscript Received: 14 JAN 2011
- Crohn's disease;
- CT enterography (CTE);
- management plan;
- level of confidence
Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care.
We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale).
CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%).
CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms. (Inflamm Bowel Dis 2011;)