title: Benefit of computed tomography enterography in Crohn's disease: effects on patient management and physician level of confidence.
abstract: BACKGROUND
  Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care.
  
  
  METHODS
  We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale).
  
  
  RESULTS
  CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%).
  
  
  CONCLUSIONS
  CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.
authors.affiliation: Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Siddiki
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Jeff L
authors.initials: JL
authors.lastname: Fidler
authors.forename: James E
authors.initials: JE
authors.lastname: Huprich
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: William S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: Paul E
authors.initials: PE
authors.lastname: Evans
authors.forename: William A
authors.initials: WA
authors.lastname: Faubion
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hanson
authors.forename: Steven B
authors.initials: SB
authors.lastname: Ingle
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Schroeder
authors.forename: William J
authors.initials: WJ
authors.lastname: Tremaine
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult