Diagnostic role of computed tomography enterography (CTE) in assessment of intra-mural and extra-intestinal CT findings in active Crohn’s disease (CD)

Background Crohn’s disease (CD) is a ruinous bowel disease, which, if left uncured, leads to penetrating bowel complications. Computed tomography enterography (CTE) is nowadays accepted as a principal modality for the assessment of small bowel diseases. The aim of this study is to assess the role of CT enterography in the identification of intramural as well as extra-intestinal CT changes yielding more thorough data about the level and severity of the disease process thus planning appropriate treatment strategy. Results From March 2017 to January 2019, 50 patients in Cairo, Egypt, who had clinical manifestations of inflammatory bowel disease, were evaluated by MDCTE. CT image analysis was processed, including anatomical localization of bowel segments affection, assessment of mucosal thickening and hyper-enhancement, and extra-enteric affection. Diagnosis of Crohn’s disease (CD) was confirmed by endoscopy and histopathology; mucosal thickening was seen in 42 patients (84%), mucosal hyper-enhancement was seen in 44 patients (88%) while engorgement of vasa recta (comb’s sign) was seen in 38 patients (76%). Conclusion Although ileocolonoscopy is a proven sensitive method to detect mucosal injury and diagnose disease activity, it is limited by its maximal extent and inability to detect transmural complications as well as limited ability to assess deep bowel wall involvement. CT enterography (CTE) is a valuable technique in diagnostic evaluation of intramural and extra-intestinal involvement in Crohn’s disease (CD) during disease activity.