Ex vivo histology-correlated optical coherence tomography in the detection of transmural inflammation in Crohn's disease.
OBJECTIVE
Distinguishing Crohn's disease (CD) from ulcerative colitis (UC) can be difficult. Transmural inflammation, a key feature of CD, cannot be assessed by conventional colonoscopy with biopsy. Optical coherence tomography (OCT) provides high-resolution, cross-sectional images of the gut wall and might become a new diagnostic tool. The aims of this study were to perform histology-correlated OCT on surgical specimens of CD and UC and to determine its diagnostic accuracy.


METHODS
Colectomy specimens from patients with a preoperative diagnosis of CD (N = 24) or UC (N = 24) were studied with OCT in the operating room. OCT and histopathology were assessed blindly, and diagnostic accuracy of OCT was assessed.


RESULTS
Eight preoperatively identified UC patients (33%) with transmural inflammation on postoperative histology were diagnosed with CD, and all 8 had a disrupted layered structure on OCT, a characteristic feature of transmural disease. Sixteen UC patients (67%) had superficial inflammation on histology; of them, 13 (81%) had an intact layered structure on OCT. All 24 preoperative CD patients had transmural inflammation on histology, and 23 (96%) had a disrupted layered structure on OCT. Of 585 histology-OCT image sets from the 48 patients, 152 sets (26%) had transmural inflammation on histology. The sensitivity and specificity for OCT to detect transmural disease were 86% and 91%, respectively.


CONCLUSIONS
Transmural inflammation, as characterized by disruption of the layered structure of colon wall on OCT, is an accurate marker for the diagnosis of CD. Ex vivo OCT predicted transmural inflammation on postoperative histopathology.
Shen
Bo
B
Department of Gastroenterology/Hepatology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. shenb@ccf.org
Zuccaro
Gregory
G
Gramlich
Terry L
TL
Gladkova
Natalie
N
Lashner
Bret A
BA
Delaney
Conor P
CP
Connor
Jason T
JT
Remzi
Feza H
FH
Kareta
Margaret
M
Bevins
Charles L
CL
Feldchtein
Felix
F
Strong
Scott A
SA
Bambrick
Marlene L
ML
Trolli
Patricia
P
Fazio
Victor W
VW
D000328:Adult; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003424:Crohn Disease / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence