title: Detection and differentiation of inflammatory versus fibromatous Crohn's disease strictures: prospective comparison of 18F-FDG-PET/CT, MR-enteroclysis, and transabdominal ultrasound versus endoscopic/histologic evaluation.
abstract: BACKGROUND
  Differentiation between inflammatory and fibromatous strictures in Crohn's disease (CD) is difficult but crucial for therapeutic decisions. The aim of this study was to assess the best noninvasive imaging method for the detection and differentiation of inflammatory and fibromatous stenoses in CD in comparison to endoscopic and histologic evaluation.
  
  
  METHODS
  Patients with suspected CD strictures were included. According to a formalized endoscopic and histologic protocol, strictures were classified as inflammatory, mixed, and fibrostenotic. Strictures were further analyzed using fluorine 18-labeled fluoro-2-deoxy-D-glucose ((18) FDG) / positron emission tomography (PET) low-dose computed tomography (CT), magnetic resonance (MR) enteroclysis and transabdominal ultrasound using standardized scoring systems.
  
  
  RESULTS
  Thirty patients with 37 strictures were evaluated (inflamed n = 22; mixed n = 12, fibromatous n = 3). (18) FDG-PET/CT detected 81%, MR-enteroclysis 81%, and ultrasound 68% of the strictures. Correct differentiation rates of strictures were 57% for MRE, 53% for (18) FDG-PET/CT, and 40% for ultrasound. Differences of detection rates and differentiation rates were not statistically significant. When combining transabdominal ultrasound with (18) FDG-PET/CT or MR-enteroclysis all strictures that required invasive treatment were detected.
  
  
  CONCLUSIONS
  Detection rates of the strictures were not significantly different between (18) FDG-PET/CT, MR-enteroclysis, and ultrasound. Despite good stricture detection rates relating to our gold standard, (18) FDG-PET/CT nor MR-enteroclysis nor ultrasound can accurately differentiate inflamed from fibrotic strictures. A combination of MR-enteroclysis and ultrasound as well as a combination of (18) FDG-PET/CT and ultrasound resulted in a 100% detection rate of strictures requiring surgery or endoscopic dilation therapy, suggesting the combination of these methods as an alternative to endoscopy at least in the group of patients not able to perform an adequate bowel preparation.
authors.affiliation: Department of Medicine B, University of Muenster, Muenster, Germany. Frank.Lenze@ukmuenster.de
authors.forename: Frank
authors.initials: F
authors.lastname: Lenze
authors.forename: Johannes
authors.initials: J
authors.lastname: Wessling
authors.forename: Janbernd
authors.initials: J
authors.lastname: Bremer
authors.forename: Hansjoerg
authors.initials: H
authors.lastname: Ullerich
authors.forename: Tillmann
authors.initials: T
authors.lastname: Spieker
authors.forename: Matthias
authors.initials: M
authors.lastname: Weckesser
authors.forename: Sarid
authors.initials: S
authors.lastname: Gonschorrek
authors.forename: Klaus
authors.initials: K
authors.lastname: Kannengiesser
authors.forename: Emile
authors.initials: E
authors.lastname: Rijcken
authors.forename: Jan
authors.initials: J
authors.lastname: Heidemann
authors.forename: Andreas
authors.initials: A
authors.lastname: Luegering
authors.forename: Otmar
authors.initials: O
authors.lastname: Schober
authors.forename: Wolfram
authors.initials: W
authors.lastname: Domschke
authors.forename: Torsten
authors.initials: T
authors.lastname: Kucharzik
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
mesh_terms: D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D003113:Colonoscopy; D003424:Crohn Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D014463:Ultrasonography; D055815:Young Adult