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http://dx.doi.org/10.3348/kjr.2018.19.6.1089

Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding  

Lee, Sunyoung (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Ye, Byong Duk (Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center)
Park, Seong Ho (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Lee, Kyung Jin (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Kim, Ah Young (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Lee, Jong Seok (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Kim, Hyun Jin (Department of Radiology and the Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
Yang, Suk-Kyun (Department of Gastroenterology and Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center)
Publication Information
Korean Journal of Radiology / v.19, no.6, 2018 , pp. 1089-1098 More about this Journal
Abstract
Objective: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. Materials and Methods: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. Results: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-${\alpha}$ therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041). Conclusion: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.
Keywords
Crohn's disease; Lower gastrointestinal bleeding; Computed tomography; Computed tomographic enterography; Diagnostic yield; Rebleeding;
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