Korean J Radiol.  2017 Dec;18(6):906-914. 10.3348/kjr.2017.18.6.906.

CT Enterography for Surveillance of Anastomotic Recurrence within 12 Months of Bowel Resection in Patients with Crohn's Disease: An Observational Study Using an 8-Year Registry

• Choi IY
• Park SH
• Park SH
• Yu CS
• Yoon YS
• Lee JL
• Ye BD
• Kim AY
• Yang SK

• KMID: 2427200
• DOI: http://doi.org/10.3348/kjr.2017.18.6.906

Abstract

OBJECTIVE
To investigate the diagnostic yield and accuracy of CT enterography (CTE) for early (< 12 postoperative months) surveillance of anastomotic recurrence after bowel resection for Crohn's disease (CD).
MATERIALS AND METHODS
We analyzed 88 adults (60 males and 28 females; mean age, 31.4 ± 9.6 years) who underwent bowel surgery for CD that created ileocolic anastomosis without enteric stoma, and underwent CTE for surveillance of CD recurrence/aggravation within 12 post-operative months. The CD activity index (CDAI) at the time of CTE was < 150 (i.e., clinically silent) in 51 patients, and ≥ 150 in 37 patients. Diagnostic yields of CTE regarding CD recurrence in the ileocolic anastomosis and extraluminal penetrating complications were determined. CTE-related step-up therapy was recorded. These outcomes were compared between the two CDAI groups after accounting for major risk factors for CD recurrence. In a subgroup of 31 patients who underwent both CTE and ileocolonoscopy within 1 month, CTE accuracy for anastomotic recurrence was assessed using the Rutgeerts scoring as the reference standard.
RESULTS
CTE diagnostic yield was 35.2% (31/88) for the anastomotic recurrence and 9.1% (8/88) for penetrating complications. 20.5% (18/88) of the patients underwent step-up therapy after CTE detection of anastomotic recurrence. These outcomes were not significantly different between CDAI < 150 and CDAI ≥ 150, except that CTE yield for extraluminal penetrating complications was significantly higher in CDAI ≥ 150 (16.2% [6/37] vs. 3.9% [2/51]; multivariable-adjusted p = 0.029). CTE showed 92.3% (12/13) sensitivity and 83.3% (15/18) specificity for anastomotic recurrence.
CONCLUSION
CTE may be a viable option for the early postsurgical surveillance of recurred disease in CD patients.

Keyword

Crohn's disease; Ileocolonic; Intestine; Follow-up; CT enterography; CTE; Monitor; Recurrent; Asymptomatic

MeSH Terms

Adult
Colon/diagnostic imaging
Colonoscopy
Crohn Disease/*diagnosis/diagnostic imaging/surgery
Female
Humans
Ileum/diagnostic imaging
Male
Recurrence
Registries
Sensitivity and Specificity
*Tomography, X-Ray Computed
Young Adult

Figure

• 

  Fig. 1 Recurred CD in anastomotic region, i.e., ileum just proximal to ileocolonic anastomosis, seven months after bowel surgery, in 24-year-old woman. A. CTE shows mild mural thickening (4 mm thickness) and increased mural enhancement in ileum (arrows), just proximal to anastomotic line, with patchy distribution in some areas. Metallic anastomotic suture materials are noted (arrowheads). Unlike neo-terminal ileum, anastomosed colon appears unremarkable. B. Upon endoscopy, multiple small superficial aphthous lesions (arrows), indicative of mild disease, are noted in neo-terminal ileum. CD = Crohn's disease, CTE = CT enterography

• 

  Fig. 2 Recurred CD in anastomotic region, i.e., ileum just proximal to ileocolonic anastomosis, five months after bowel surgery, in 18-year-old man. A. CTE shows deep longitudinal ulcer accompanied by mural thickening and hyperenhancement in mesenteric side of neo-terminal ileum (arrows), which is specific for CD. Prominent vasa recta are also seen. Metallic anastomotic suture materials are noted (arrowheads). B. At endoscopy, large deep longitudinal ulcer (arrows) and swelling of adjacent mucosal folds are noted, which indicate severe inflammation.

• 

  Fig. 3 Recurred CD manifesting as penetrating complication at seven months after bowel surgery in 18-year-old man. CTE shows 2-cm extraluminal inflammatory lesion (arrow) adjacent to ileocolonic anastomosis (arrowheads), which contains air-bubble to indicate fistulous communication with bowel.

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