Korean J Radiol.  2018 Dec;19(6):1089-1098. 10.3348/kjr.2018.19.6.1089.

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

• Lee S
• Ye BD
• Park SH
• Lee KJ
• Kim AY
• Lee JS
• Kim HJ
• Yang SK

• KMID: 2424848
• DOI: http://doi.org/10.3348/kjr.2018.19.6.1089

Abstract

OBJECTIVE
To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding.
MATERIALS AND METHODS
A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis.
RESULTS
The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041).
CONCLUSION
The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

Keyword

Crohn's disease; Lower gastrointestinal bleeding; Computed tomography; Computed tomographic enterography; Diagnostic yield; Rebleeding

MeSH Terms

Cohort Studies
Crohn Disease*
Follow-Up Studies
Hemorrhage*
Humans
Necrosis
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Flow diagram of study patients.CD = Crohn's disease, CT = computed tomography, LGIB = lower gastrointestinal bleeding

• 

  Fig. 2 20-year-old male patient with CD presenting with acute severe LGIB.Axial (A) and coronal (B) CTE images show contrast extravasation into bowel lumen (arrows), indicating ongoing bleeding in ileal area that shows mural thickening and hyperenhancement, ulcers, and increased vasa recta, which are signs of active Crohn's inflammation. CTE = CT enterography

• 

  Fig. 3 Cumulative probability of recurred severe LGIB in 62 patients who were examined with CTE and showed negative CTE results for bowel bleeding.Overall result (A) and results according to disease extent assessed with CTE (B), bowel-to-artery enhancement ratio assessed with CTE (C), and anti-TNF-α therapy after index bleeding (D). CI = confidence interval, HR = hazard ratio, TNF = tumor necrosis factor

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