A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography
Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve p...
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| Veröffentlicht in: | Inflammatory bowel diseases 2023-01, Vol.29 (1), p.42-50 |
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| creator | Khosravi, Bardia Salehnia, Aneseh Pak, Neda Montazeri, S Ali Sima, Ali Reza Vahedi, Homayoun Malekzadeh, Reza Radmard, Amir Reza |
| description | Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings.
After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices.
Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%.
Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI. |
| doi_str_mv | 10.1093/ibd/izac040 |
| format | Article |
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After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices.
Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%.
Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI.</description><identifier>ISSN: 1078-0998</identifier><identifier>EISSN: 1536-4844</identifier><identifier>DOI: 10.1093/ibd/izac040</identifier><identifier>PMID: 35259254</identifier><language>eng</language><publisher>England</publisher><subject>Colitis, Ulcerative - pathology ; Crohn Disease - pathology ; Humans ; Ileitis - pathology ; Ileum - pathology ; Magnetic Resonance Imaging - methods</subject><ispartof>Inflammatory bowel diseases, 2023-01, Vol.29 (1), p.42-50</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c289t-8ced93e4b81f3718e08080f97109a7f740b4278f261a5c496e846330d512fa8b3</citedby><cites>FETCH-LOGICAL-c289t-8ced93e4b81f3718e08080f97109a7f740b4278f261a5c496e846330d512fa8b3</cites><orcidid>0000-0002-1397-4846 ; 0000-0002-7462-118X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35259254$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khosravi, Bardia</creatorcontrib><creatorcontrib>Salehnia, Aneseh</creatorcontrib><creatorcontrib>Pak, Neda</creatorcontrib><creatorcontrib>Montazeri, S Ali</creatorcontrib><creatorcontrib>Sima, Ali Reza</creatorcontrib><creatorcontrib>Vahedi, Homayoun</creatorcontrib><creatorcontrib>Malekzadeh, Reza</creatorcontrib><creatorcontrib>Radmard, Amir Reza</creatorcontrib><title>A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography</title><title>Inflammatory bowel diseases</title><addtitle>Inflamm Bowel Dis</addtitle><description>Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings.
After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices.
Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%.
Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI.</description><subject>Colitis, Ulcerative - pathology</subject><subject>Crohn Disease - pathology</subject><subject>Humans</subject><subject>Ileitis - pathology</subject><subject>Ileum - pathology</subject><subject>Magnetic Resonance Imaging - methods</subject><issn>1078-0998</issn><issn>1536-4844</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kN1LwzAUxYMoTqdPvkveFKQuX22Txzk3HUwUmc8lTdMt2o-ZpOj8681YlfNwD9xzD9wfABcY3WIk6Mjkxcj8SIUYOgAnOKZJxDhjh8GjlEdICD4Ap869I0SCxDEY0JjEgsTsBORj-GKl8kbJCs6bQn9D38J747xpVp1xa3gn1ceXDGZeaeONgzPb1nBi23Vz5eBS29o0u9t-axr49Aqnjde2XVm5WW_PwFEpK6fP-zkEb7PpcvIYLZ4f5pPxIlKECx9xpQtBNcs5LmmKuUY8qBRpeFKmZcpQzkjKS5JgGSsmEs1ZQikqYkxKyXM6BNf73o1tPzvtfFYbp3RVyUa3nctIQtOY4wSzEL3ZR5VtnbO6zDbW1NJuM4yyHdQsQM16qCF92Rd3ea2L_-wfRfoLSahykg</recordid><startdate>20230105</startdate><enddate>20230105</enddate><creator>Khosravi, Bardia</creator><creator>Salehnia, Aneseh</creator><creator>Pak, Neda</creator><creator>Montazeri, S Ali</creator><creator>Sima, Ali Reza</creator><creator>Vahedi, Homayoun</creator><creator>Malekzadeh, Reza</creator><creator>Radmard, Amir Reza</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1397-4846</orcidid><orcidid>https://orcid.org/0000-0002-7462-118X</orcidid></search><sort><creationdate>20230105</creationdate><title>A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography</title><author>Khosravi, Bardia ; Salehnia, Aneseh ; Pak, Neda ; Montazeri, S Ali ; Sima, Ali Reza ; Vahedi, Homayoun ; Malekzadeh, Reza ; Radmard, Amir Reza</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c289t-8ced93e4b81f3718e08080f97109a7f740b4278f261a5c496e846330d512fa8b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Colitis, Ulcerative - pathology</topic><topic>Crohn Disease - pathology</topic><topic>Humans</topic><topic>Ileitis - pathology</topic><topic>Ileum - pathology</topic><topic>Magnetic Resonance Imaging - methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khosravi, Bardia</creatorcontrib><creatorcontrib>Salehnia, Aneseh</creatorcontrib><creatorcontrib>Pak, Neda</creatorcontrib><creatorcontrib>Montazeri, S Ali</creatorcontrib><creatorcontrib>Sima, Ali Reza</creatorcontrib><creatorcontrib>Vahedi, Homayoun</creatorcontrib><creatorcontrib>Malekzadeh, Reza</creatorcontrib><creatorcontrib>Radmard, Amir Reza</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Inflammatory bowel diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khosravi, Bardia</au><au>Salehnia, Aneseh</au><au>Pak, Neda</au><au>Montazeri, S Ali</au><au>Sima, Ali Reza</au><au>Vahedi, Homayoun</au><au>Malekzadeh, Reza</au><au>Radmard, Amir Reza</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography</atitle><jtitle>Inflammatory bowel diseases</jtitle><addtitle>Inflamm Bowel Dis</addtitle><date>2023-01-05</date><risdate>2023</risdate><volume>29</volume><issue>1</issue><spage>42</spage><epage>50</epage><pages>42-50</pages><issn>1078-0998</issn><eissn>1536-4844</eissn><abstract>Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings.
After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices.
Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%.
Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI.</abstract><cop>England</cop><pmid>35259254</pmid><doi>10.1093/ibd/izac040</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-1397-4846</orcidid><orcidid>https://orcid.org/0000-0002-7462-118X</orcidid></addata></record> |
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| ispartof | Inflammatory bowel diseases, 2023-01, Vol.29 (1), p.42-50 |
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| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Colitis, Ulcerative - pathology Crohn Disease - pathology Humans Ileitis - pathology Ileum - pathology Magnetic Resonance Imaging - methods |
| title | A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography |
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