title: Mesenteric findings of CT enterography are well correlated with the endoscopic severity of Crohn's disease.
abstract: BACKGROUND
  Maintenance of mucosal healing is a primary goal when treating Crohn's disease (CD). Endoscopy is the most precise method for the assessment of mucosal healing, but is considered overly invasive for patients with CD. In contrast, CT enterography (CTE) is less invasive, but little is known about the correlation between mucosal status and CTE parameters.
  
  
  METHODS
  We recruited CD patients who underwent CTE and double balloon endoscopy (DBE) on the same day at our hospital between 2012 and 2014. CTE parameters evaluated included bowel-wall thickening, mural hyperenhancement, mural stratification (target sign), submucosal fat deposition, mesenteric hypervascularity (comb sign), increased fat density, mesenteric fibrofatty proliferation, enlarged mesenteric lymph nodes, and stenosis/sacculation. Endoscopic findings were evaluated using the Simple Endoscopic Score for Crohn's Disease (SES-CD). CTE parameters that were predictive of higher values in the SES-CD were extracted statistically.
  
  
  RESULTS
  Forty-one patients were recruited, from which 191 intestinal segments were evaluated. Spearman's rank correlation coefficients showed that the majority of CTE values exhibited mild to moderate correlations with SES-CD values. Notably, multiple ordinal logistic regression analysis demonstrated that CTE findings obtained from the mesenteric area, such as mesenteric hypervascularity (comb sign) and enlarged mesenteric lymph nodes, were more critical predictors of endoscopic mucosal ulceration than those obtained from the bowel wall.
  
  
  CONCLUSIONS
  This study was the first of its kind to assess correlations between CTE values and SES-CD values. Mesenteric findings of CTE, rather than mural findings, were highly correlated with the endoscopically evaluated severity of ulceration.
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Sakurai
authors.affiliation: Kashiwanoha Clinic, Chiba University, 6-2-1 Kashiwanoha, Kashiwa-shi, 277-0882, Chiba, Japan. Electronic address: katsuno@faculty.chiba-u.jp.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Katsuno
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Saito
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Sayuri
authors.initials: S
authors.lastname: Yoshihama
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Tomoo
authors.initials: T
authors.lastname: Nakagawa
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Koseki
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Taida
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ishigami
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Ken-Ichiro
authors.initials: KI
authors.lastname: Okimoto
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Maruoka
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Matsumura
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Arai
authors.affiliation: Department of Medicine and Clinical Oncology (K1), Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi 260-8670, Chiba, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Yokosuka
mesh_terms: D000293:Adolescent; D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging* / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology; D007413:Intestinal Mucosa / Q000000981:diagnostic imaging / Q000473:pathology; D007422:Intestines / Q000000981:diagnostic imaging / Q000473:pathology; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008643:Mesentery / Q000000981:diagnostic imaging / Q000473:pathology; D008875:Middle Aged; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed / Q000379:methods
keywords: CT enterography; Crohn’s disease; Enlarged mesenteric lymph nodes; Mesenteric hypervascularity (comb sign); Simple endoscopic score for crohn’s disease (SES-CD)