CT Enterography may Effectively predict Stricture Severity among patients with Crohns Disease: Study

Standardized methods of measuring and describing Crohn disease strictures by CT enterography are important for clinical decisions and therapeutic studies. Prior methods were not uniform and, therefore, have resulted in difficulty with treatment decisions or assessments for response. The objective of this study was to determine the reliability of CT enterography features that describe Crohn disease strictures and their relationship to stricture severity.

A retrospective study was conducted among 43 adults with symptomatic terminal ileal Crohn disease strictures who underwent standard-of-care CT enterography at Cleveland Clinic from January 2008 to August 2016. Four abdominal radiologists, trained on standardized definitions and blinded to all patient information, assessed imaging features of the most distal ileal stricture in two separate sessions (separated by ≥2 weeks) in random order. Features with an interrater ICC greater than or equal to 0.41 were considered reliable. Univariable and multivariable linear regression analyses determined which of these reliable features were associated with a VAS of overall stricture severity.

Results

• Examinations of 43 patients (mean age, 52 years ± 16; 23 female) were evaluated.

• Five continuous measurements and six observations demonstrated at least moderate interrater reliability (interrater ICC range, 0.42 [95% CI: 0.25, 0.57] to 0.80 [95% CI: 0.67, 0.88]).

• Ten features were univariably associated with stricture severity, and three continuous measurements—stricture length (interrater ICC, 0.64 [95% CI: 0.42, 0.81]), maximal associated small bowel dilation (interrater ICC, 0.80 [95% CI: 0.67, 0.88]), and maximal stricture wall thickness (interrater ICC, 0.50 [95% CI: 0.34, 0.62])—were independently associated (P <.001 to .003) with stricture severity in a multivariable model.

• These measurements were used to derive a well-calibrated (optimism-adjusted calibration slope = 1.00) quantitative model of stricture severity.

This study firmly establishes that standardized CT enterography measurements describe terminal ileal Crohn disease strictures in a reliable way. It shows that some of those measures—stricture length, maximal associated small bowel dilation, and maximal wall thickness—are reliable indicators of stricture severity and may help better assess and manage Crohn's disease and antistricture therapy trials.

Researchers described that CT enterography measurements of stricture length, maximal associated small bowel dilation, and maximal stricture wall thickness are useful markers of stricture severity in Crohn disease. Such findings are pivotal for clinical decision-making and the evaluation of antistricture therapy efficacy.

Reference:

Rieder, F., Ma, C., Hanzel, J., Fletcher, J. G., Baker, M. E., Wang, Z., Guizzetti, L., Shackelton, L. M., Rémillard, J., Patel, M., Niu, J., Ottichilo, R., Santillan, C. S., Capozzi, N., Taylor, S. A., Bruining, D. H., Zou, G., Feagan, B. G., Jairath, V., … Atzen, S. (2024). Reliability of CT enterography for describing fibrostenosing Crohn disease. Radiology, 312(2). https://doi.org/10.1148/radiol.233038