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Ahn, Park, Moon, Lim, Lee, Ko, and Kim: Comparative Study between Axial and Coronal Planes of CT Enterography in Evaluation of Disease Activity and Complications of Crohn Disease
Abdominal Radiology
Journal of the Korean Society of Radiology

Journal of the Korean Society of Radiology 2013; 68(2): 107-115.

Published online: 15 February 2013

DOI: https://doi.org/10.3348/jksr.2013.68.2.107

Comparative Study between Axial and Coronal Planes of CT Enterography in Evaluation of Disease Activity and Complications of Crohn Disease

Sung Eun Ahn, MD1, Seong Jin Park, MD1, Soung Kyung Moon, MD1, Joo Won Lim, MD1, Dong Ho Lee, MD1, Young Tae Ko, MD1, Hyo Jong Kim, MD2

1Department of Diagnostic Radiology, Kyung Hee University Hospital, Seoul, Korea.

2Department of Gastroenterology, Kyung Hee University Hospital, Seoul, Korea.

Corresponding author: Seong Jin Park, MD. Department of Diagnostic Radiology, Kyung Hee University Hospital, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 130-872, Korea. Tel. 82-2-958-8610, Fax. 82-2-968-0787, indawn@hanafos.com

Received 20 August 2012       Accepted 1 November 2012

Copyright © 2013 The Korean Society of Radiology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To retrospectively compare the accuracy of axial and coronal planes of CT enterography for detection of pathologic findings of Crohn disease.

Materials and Methods

168 patients who were suspected of having Crohn disease underwent CT enterography. 66 patients who were diagnosed Crohn disease were retrospectively evaluated (endoscopic biopsy of terminal ileum: 12 patients, segmental resection of small bowel: 6 patients, diagnosed based on a combination of clinical, histopathological and imaging findings: 48 patients). 2 radiologists reviewed axial planes of CT enterography and one month later reviewed coronal planes. CT enterography findings of active phase, chronic phase and complications of Crohn disease were evaluated and then compared with axial and coronal planes by using chi-square test.

Results

Mucosal hyperenhancement, wall thickening, and mesenteric fat stranding were more detected on axial planes, which were CT findings of active Crohn disease. Pseudosacculation, fibrotic strictures, fistulas, abscesses were more detected on coronal planes, which were CT findings of chronic Crohn disease or complications. In particular, pseudosacculation and fibrotic strictures were significantly more detected on coronal planes.

Conclusion

When evaluating CT enterography in Crohn disease, coronal planes provide more useful diagnostic information of pseudosacculation and fibrotic strictures.

Keywords: Crohn Disease, CT, CT Enterography

Figures and Tables

Fig. 1
Flowchart of the selection of patients for retrospective study, with all patients undergoing CT enterography and ileocoloscopy with biopsy within 30 days.
Note.-GIST = gastrointestinal stromal tumor, P-J syndrome = Peutz-Jegher syndrome, Tb enteritis = Tuberculous enteritis, UC = ulcerative colitis
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Fig. 2
A 19-year-old man with Crohn disease at the ileum. CT enterogram shows concentric wall thickening and mucosal hyperenhancement (arrows) at the ileum on axial image (A), which were missed on coronal image (B).
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Fig. 3
A 24-year-old man with active Crohn disease at the ascending colon and ileum.
A, B. CT enterogram shows concentric wall thickening and mucosal hyperenhancement (arrows) at the ileum on axial image. The thickened wall has a stratified appearance. CT enterography also shows increased attenuation of the mesenteric fat on axial image, which was not shown on coronal image.
C. Endoscopy image shows erythematous mucosal change at the ileocecal valve.
D. Image from barium study demonstrates transient luminal narrowing, mucosal fold widening and thickening on the proximal ascending colon and the terminal ileum.
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Fig. 4
A 31-year-old man with long-standing Crohn disease at the ileum. CT enterogram shows typical straightening of the mesenteric boder (arrows), a finding that indicates linear ulceration or ulcer scar and pseudosacculation of the antimesenteric border (arrowhead) at the ileum on coronal image.
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Fig. 5
A 27-year-old man with fibrotic stricture in Crohn disease.
A, B. CT enterogram shows fibrotic stricture (arrows) at the pelvic ileal loop on coronal image, which was missed on axial image.
C. Image from barium study also shows typical fibrotic stricture (arrows) at the pelvic ileal loop.
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Fig. 6
A 27-year-old woman with fibrotic stricture in Crohn disease.
A-C. CT enterogram shows fibrotic stricture (arrows) at the ileocecal (IC) valve with dilatation of terminal ileum on serial coronal images, which was missed on axial image.
D. Endoscopy image shows numerous pseudopolyp and cecal deformity. Scope couldn't be passed of stenotic portion of IC valve.
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Fig. 7
A 23-year-old woman with ileo-colonic fistula in Crohn disease.
A-E. CT enterography shows ileo-colonic fistula on serial coronal images, which was missed on axial image. Fistula extends from the distal ileum (arrowheads) to the adjacent distal sigmoid colon (open arrows).
F. Image from barium study obtained after 4 hours, demonstrates ileocolonic fistula on sagittal image (arrow). Sigmoid colon (open arrow) and rectum are seen.
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Table 1
Scan Parameters for CT Enterography
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Note.-16-detector CT scanner = Light speed, GE Healthcare, Milwaukee, WI, USA, 64-detector CT scanner = Brilliance 64, Philips Medical System, Cleveland, OH, USA

Table 2
Each Numbers of Bowel Distention Score
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Data in parentheses are percentages.

Table 3
Each Numbers of Active Findings of Crohn Disease at Axial and Coronal Images
jksr-68-107-i003

Data in parentheses are percentages.

Note.-Axl = axial, Cor = coronal

Table 4
Each Numbers of Chronic Findings of Crohn Disease at Axial and Coronal Images
jksr-68-107-i004

Data in parentheses are percentages.

Note.-Axl = axial, Cor = coronal

Table 5
Statistical Analysis and Significantly More Detected on Coronal Image
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Data in parentheses are percentages, p-value less than or equal to 0.05 was considered to indicate a statistically significant difference.

Table 6
Each Numbers of Complication Findings of Crohn Disease at Axial and Coronal Images
jksr-68-107-i006

Data in parentheses are percentages.

Note.-Axl = axial, Cor = coronal

Table 7
Each Numbers of Large Bowel and Perianal Involvement Findings of Crohn Disease at Axial and Coronal Images
jksr-68-107-i007

Data in parentheses are percentages.

Note.-Axl = axial, Cor = coronal

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