BACKGROUND AND AIMS Our goal was to determine the importance of ileal inflammation at computed tomography or magnetic resonance enterography in Crohn's disease patients with normal ileoscopy. METHODS Patients with negative ileoscopy and biopsy within 30 days of CT or MR enterography showing ileal inflammation were included. The severity [0-3 scale] and length of inflammation within the distal 20 cm of the terminal ileum were assessed on enterography. Subsequent medical records were reviewed for ensuing surgery, ulceration at ileoscopy, histological inflammation, or new or worsening ileal inflammation or stricture on enterography. Imaging findings were classified as: Confirmed Progression [subsequent surgery or radiological worsening, new ulcers at ileoscopy or positive histology]; Radiologic Response [decreased inflammation with medical therapy]; or Unlikely/Unconfirmed Inflammation. RESULTS Of 1471 patients undergoing enterography and ileoscopy, 112 [8%] had imaging findings of inflammation with negative ileoscopy, and 88 [6%] had negative ileoscopy and ileal biopsy. Half [50%; 44/88] with negative biopsy had moderate/severe inflammation at enterography, with 45%, 32% and 11% having proximal small bowel inflammation, stricture or fistulas, respectively. Two-thirds with negative biopsy [67%; 59/88] had Confirmed Progression, with 68%, 70% and 61% having subsequent surgical resection, radiological worsening or ulcers at subsequent ileoscopy, respectively. Mean length and severity of ileal inflammation in these patients was 10 cm and 1.6. Thirteen [15%] patients had Radiologic Response, and 16 [18%] had Unlikely/Unconfirmed Inflammation. CONCLUSION Crohn's disease patients with unequivocal imaging findings of ileal inflammation at enterography despite negative ileoscopy and biopsy are likely to have active inflammatory Crohn's disease. Disease detected by imaging may worsen over time or respond to medical therapy.

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计算机断层扫描和磁共振肠造影对回肠炎症的影像学发现：当回肠镜和活检阴性时，这意味着什么？

背景与目的我们的目标是确定在具有正常回肠镜的克罗恩病患者中，计算机断层扫描或磁共振肠造影对回肠炎症的重要性。方法包括在30天内CT或MR肠镜检查显示回肠炎症的阴性回肠镜检查和活检的患者。在肠回肠检查中评估了回肠末端20 cm内的炎症严重程度[0-3等级]和炎症长度。回顾了随后的医疗记录，以确保随后的手术，回肠镜溃疡，组织学炎症，新的或恶化的回肠炎症或肠造影狭窄。影像学检查结果分类为：确诊进展[随后的手术或影像学恶化，回肠镜新溃疡或组织学阳性]；放射学反应[药物治疗减少炎症]；或不太可能/未经证实的炎症。结果在1471例接受肠镜和回肠镜检查的患者中，有112例[8％]的回肠镜检查结果为阴性，而88例[6％]的回肠镜检查和回肠活检结果为阴性。一半[50％; [44/88]活检阴性的患者在小肠造影时出现中度/重度炎症，其中近端小肠炎症，狭窄或瘘管分别占45％，32％和11％。三分之二活检阴性[67％；[59/88]已确认进展，其中68％，70％和61％的患者随后进行了手术切除，放射学恶化或在随后的回肠镜检查时出现溃疡。这些患者中回肠炎症的平均长度和严重程度分别为10 cm和1.6。十三名[15％]患者有放射学反应，和16 [18％]有不太可能/未经证实的炎症。结论尽管回肠镜检查和活检阴性，但在肠造影时明确显示回肠炎症的克罗恩病患者仍可能患有活动性炎症性克罗恩病。通过成像检测到的疾病可能会随着时间的流逝而恶化或对药物治疗产生反应。