CT enterography and fistulizing Crohn's disease: clinical benefit and radiographic findings.
BACKGROUND
To estimate the clinical benefit of CT enterography (CTE) in patients with fistulizing Crohn's disease and describe the appearance of fistulas at CTE.


METHODS
Crohn's patients who had undergone CTE, which diagnosed an abscess or fistula, were identified. A gastroenterologist reviewed clinical notes prior to and following CTE to assess the pre-CTE clinical suspicion for fistula/abscess, and post-CTE alteration in patient management. A radiologist reassessed all fistula-positive cases, which were confirmed by a non-CT reference standard, to describe their radiologic appearance.


RESULTS
Fifty-six patients had CT exams identifying 19 abscesses and 56 fistulas. There was no or remote suspicion of fistula or abscess at pre-imaging clinical assessment in 50% of patients. Thirty-four patients (61%) required a change in or initiation of medical therapy and another 10 (18%) underwent an interventional procedure based on CT enterography findings. Among 37 fistulas with reference standard confirmation, 30 (81%) were extraenteric tracts, and 32 (86%) were hyperenhancing compared to adjacent bowel loops. Most fistulas (68%) contained no internal air or fluid.


CONCLUSIONS
CTE detects clinically occult fistulas and abscesses, resulting in changes in medical management and radiologic or surgical intervention. Most fistulas appear as hyperenhancing, extraenteric tracts, usually without internal air or fluid.
Booya
Fargol
F
Department of Radiology, Mayo Clinic Rochester, Rochester, MN 55905, USA.
Akram
Salma
S
Fletcher
Joel G
JG
Huprich
J E
JE
Johnson
C D
CD
Fidler
J L
JL
Barlow
J M
JM
Solem
C A
CA
Sandborn
W J
WJ
Loftus
Edward V
EV
D000038:Abscess / Q000000981:diagnostic imaging* / Q000209:etiology; D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*