Intest Res.  2017 Apr;15(2):149-159. 10.5217/ir.2017.15.2.149.

Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn's disease: a systematic review with meta-analysis

• Kedia S
• Sharma R
• Sreenivas
• Madhusudhan KS
• Sharma V
• Bopanna S
• Pratap Mouli V
• Dhingra R
• Yadav DP
• Makharia G
• Ahuja V

• KMID: 2425155
• DOI: http://doi.org/10.5217/ir.2017.15.2.149

Abstract

Abdominal computed tomography (CT) can noninvasively image the entire gastrointestinal tract and assess extraintestinal features that are important in differentiating Crohn's disease (CD) and intestinal tuberculosis (ITB). The present meta-analysis pooled the results of all studies on the role of CT abdomen in differentiating between CD and ITB. We searched PubMed and Embase for all publications in English that analyzed the features differentiating between CD and ITB on abdominal CT. The features included comb sign, necrotic lymph nodes, asymmetric bowel wall thickening, skip lesions, fibrofatty proliferation, mural stratification, ileocaecal area, long segment, and left colonic involvements. Sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio (DOR) were calculated for all the features. Symmetric receiver operating characteristic curve was plotted for features present in >3 studies. Heterogeneity and publication bias was assessed and sensitivity analysis was performed by excluding studies that compared features on conventional abdominal CT instead of CT enterography (CTE). We included 6 studies (4 CTE, 1 conventional abdominal CT, and 1 CTE+conventional abdominal CT) involving 417 and 195 patients with CD and ITB, respectively. Necrotic lymph nodes had the highest diagnostic accuracy (sensitivity, 23%; specificity, 100%; DOR, 30.2) for ITB diagnosis, and comb sign (sensitivity, 82%; specificity, 81%; DOR, 21.5) followed by skip lesions (sensitivity, 86%; specificity, 74%; DOR, 16.5) had the highest diagnostic accuracy for CD diagnosis. On sensitivity analysis, the diagnostic accuracy of other features excluding asymmetric bowel wall thickening remained similar. Necrotic lymph nodes and comb sign on abdominal CT had the best diagnostic accuracy in differentiating CD and ITB.

Keyword

Crohn disease; Intestinal tuberculosis; Necrotic lymph nodes; Comb sign

MeSH Terms

Abdomen
Colon
Crohn Disease*
Diagnosis
Gastrointestinal Tract
Humans
Lymph Nodes
Odds Ratio
Population Characteristics
Publication Bias
ROC Curve
Sensitivity and Specificity
Tomography, X-Ray Computed
Tuberculosis*

Figure

• 

  Fig. 1 Flowchart showing the selection of the studies included in the meta-analysis. ITB, intestinal tuberculosis.

• 

  Fig. 2 Forest plots and summary receiver operating characteristic (sROC) curve for comb sign. AUC, area under the curve.

• 

  Fig. 3 Forest plots and summary receiver operating characteristic (sROC) curve for skip lesions. AUC, area under the curve.

• 

  Fig. 4 Forest plots and summary receiver operating characteristic (sROC) curve for necrotic lymph nodes. AUC, area under the curve.

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