title: A Fixed Stricture on Routine Cross-sectional Imaging Predicts Disease-Related Complications and Adverse Outcomes in Patients with Crohn's Disease.
abstract: Patients with Crohn's disease (CD) typically undergo multiple cross-sectional imaging exams including computed tomography and magnetic resonance enterography during the course of their disease. The aim was to identify imaging findings that predict future disease-related poor outcomes.
  
  
  
  This was a retrospective, case control study at a single tertiary center. Cases were CD patients diagnosed with complications (bowel obstruction, perforation, internal fistula, or abscess); controls were CD patients without complications. Two radiologists blinded to clinical outcomes, independently scored cross-sectional imaging examinations obtained before the complication.
  
  
  
  One hundred eight patients (67 F; 41 M) with CD (51 cases; 57 controls) were included. For the cases, 21 had internal fistulae, 15 had bowel obstructions, 13 had abdominal abscesses, and 2 developed bowel perforations. Patients with complications were more likely to have a fixed small bowel stricture on cross-sectional imaging (P = 0.01). A patient with a stricture and upstream dilatation was 3.4 times more likely to develop a complication in the next 2 years. When present in the setting of hypervascularity and/or evidence of active inflammation, the risk increased further to 15-fold. Cases were more likely to be active smokers (29% versus 12%, P = 0.033). Cases had more evidence of inflammation based on higher Harvey Bradshaw Index values and inflammatory biomarkers and lower hemoglobin values.
  
  
  
  Information from radiologic studies, especially the presence of fixed strictures, can predict future CD complications. These findings, along with smoking and ongoing inflammation, should alert the clinician to the possibility of future complications.
authors.affiliation: *Division of Gastroenterology, Department of Medicine, University of Florida, Gainesville, Florida; Departments of †Medicine, ‡Radiology, and §Biostatistics, University of Florida, Gainesville, Florida; ‖Department of Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, New York; and ¶Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Naueen A
authors.initials: NA
authors.lastname: Chaudhry
authors.forename: Michael
authors.initials: M
authors.lastname: Riverso
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Grajo
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Moser
authors.forename: Fei
authors.initials: F
authors.lastname: Zou
authors.forename: Maher
authors.initials: M
authors.lastname: Homsi
authors.forename: Darashana R
authors.initials: DR
authors.lastname: Punglia
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Zimmermann
mesh_terms: D018784:Abdominal Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology; D007421:Intestine, Small / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult