Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography

Purpose: To retrospectively evaluate small-bowel enhancement characteristics and the sensitivity, specificity, and interobserver agreement of computed tomographic (CT) findings by using histologic and endoscopic results as a reference A standard in patients undergoing enteric phase CT enterography. Materials and Methods: The institutional review board approved this retrospective HIPAA-compliant study, which included patients who consented to having their medical records used for research purposes. Enteric phase CT enterographic and ileoscopic findings with or without ileal histologic results were examined in 42 patients (24 women, 18 men). Enteric phase CT enterography was performed after 150 mL of intravenous contrast, material was administered at 4 mL/sec, with a 45-second delay. Mural attenuation was measured in the distended and collapsed jejunal and ileal loops and in the terminal ileum. Two radiologists examined CT images for findings of Crohn disease. Mural attenuation for different bowel loops was compared by using a Student t test, with K statistics used to measure interobserver agreement and Pearson correlation coefficients used to compare visual and quantitative measures. Results: Distended jejunal loops had significantly greater attenuation than distended ileal loops (113 HU vs 72 HU; P < .001). Attenuation of collapsed jejunal (134 HU) and ileal (108 HU) loops was greater than that of distended jejunal and ileal loo's (P < .001). Terminal ileal enhancement was the most sensitive visual CT finding of Crohn disease for both radiologist's. Mural thickening demonstrated the greatest interobserver agreement (kappa = 0.83). Visual enhancement and quantitative mural attenuation were significantly correlated (P < .003). Conclusion: At enteric phase CT enterography, jejunal attenuation is greater than ileal attenuation and collapsed bowel loops demonstrate greater attenuation than distended bowel loops. Mural hyperenhancement and increased mural thickness are the most sensitive CT findings of active Crohn disease.