title: Computed tomography enterography detects intestinal wall changes and effects of treatment in patients with Crohn's disease.
abstract: OBJECTIVE
  The use of computed tomography enterography (CTE) in patients with Crohn's disease has increased. However, there is little data available on how radiologic parameters of active disease change during treatment with infliximab and whether these changes correspond to symptoms, serum biomarkers, or endoscopic appearance.
  
  
  METHODS
  We performed a retrospective study of patients with Crohn's disease who had undergone serial CTE imaging while receiving infliximab. Lesions were defined as improved if their enhancement or length decreased without worsening of other parameters. Patients were grouped as responders (all lesions improved), partial responders (some lesions improved), and nonresponders (worsening or no changes in all lesions). Of the 63 patients identified (47% female), the median age was 37.7 years, the median disease duration was 7.6 years, and the median time between initial and first follow-up CTE was 356 days (interquartile range, 215-630).
  
  
  RESULTS
  Of 105 lesions, 52 (49.5%) improved, 11 (10.5%) remained unchanged, and 42 (40.0%) worsened. Per patient, 28 (44.4%) were responders, 12 (19.0%) were partial responders, and 23 (36.5%) were nonresponders. The radiologic response had poor-to-fair agreement with symptoms, endoscopic appearance, and levels of C-reactive protein at time of second CTE (κ = 0.26, 0.07, and 0.30 respectively).
  
  
  CONCLUSIONS
  Radiologic improvement was observed in 63.4% of patients with Crohn's disease who received infliximab therapy, despite a study design that was likely biased toward nonresponders. Radiologic response was not in good agreement with clinical symptoms, serum biomarkers, or endoscopic appearance; CTE might be used as a complementary approach to identify mural healing or inflammation not detected by other methods.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota 55905, USA. bruining.david@mayo.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Eric C
authors.initials: EC
authors.lastname: Ehman
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Siddiki
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Nguyen
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: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Joel G
authors.initials: JG
authors.lastname: Fletcher
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D003424:Crohn Disease / Q000175:diagnosis* / Q000188:drug therapy* / Q000473:pathology; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D000069285:Infliximab; D007422:Intestines / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D015415:Biomarkers; D007155:Immunologic Factors; D000069285:Infliximab