Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital. Issue 2 (14th December 2020)

• Record Type: Journal Article
• Authors: Israrahmed, Amrin; Yadav, Rajanikant R; Yadav, Geeta; Alpana, ; Helavar, Rajesh V; Rai, Praveer; Jain, Manoj Kumar; Gupta, Archna
• Is Part Of: JGH open. Volume 5:Issue 2(2021)
• Page Start: 180
• Page End: 189
• Publication Date: 2020-12-14
• Subjects: Crohn's disease -- computed tomography enteroclysis -- computed tomography enterography -- gastrointestinal tuberculosis
• DOI: 10.1002/jgh3.12478
• Languages: English
• ISSNs: 2397-9070

Abstract

Abstract: Background and Aim: Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD. Methods: A total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed "CTE case record form" and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis. Results: Final diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel‐related diseases. The sensitivity of CTE (ITB vs CD, 90.2 vs 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB vs CD, 87 vs 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically ( P < 0.001) seen in patients with CD, and necrotic ( P = 0.002) and calcified ( P = 0.055) lymph nodes were specifically seen in patients with ITB. Conclusion: We propose a systematic approach to the radiological differentiation of ITB from CD. Abstract : Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. Computed tomography with enteroclysis/enterography can resolve the dilemma of ITB and CD to a great extent with the help of the enhancement pattern of bowel lesions and specific ancillary findings. By forming objective criteria and with the help of format‐based reporting, the various interobserver variations can be reduced, and radiologists can arrive at a more confident diagnosis.