Background & Aims

Postoperative Crohn’s disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging is less clear. We evaluated the concordance of cross-sectional enterography with endoscopic recurrence and the predictive ability of radiography for future CD postoperative recurrence.

Methods

We performed a multi-institution retrospective cohort study of postoperative adult patients with CD who underwent ileocolonoscopy and cross-sectional enterography within 90 days of each other following ileocecal resection. Imaging studies were interpreted by blinded, expert CD radiologists. Patients were categorized by presence of endoscopic postoperative recurrence (E+) (modified Rutgeerts’ score ≥i2b) or radiographic disease activity (R+) and grouped by concordance status.

Results

A total of 216 patients with CD with paired ileocolonoscopy and imaging were included. A majority (54.2%) exhibited concordance (34.7% E+/R+; 19.4% E−/R−) between studies. The plurality (41.7%; n = 90) were E−/R+ discordant. Imaging was highly sensitive (89.3%), with low specificity (31.8%), in detecting endoscopic postoperative recurrence. Intestinal wall thickening, luminal narrowing, mural hyper-enhancement, and length of disease on imaging were associated with endoscopic recurrence (all P < .01). Radiographic disease severity was associated with increasing Rutgeerts’ score (P < .001). E−/R+ patients experienced more rapid subsequent endoscopic recurrence (hazard ratio, 4.16; P = .033) and increased rates of subsequent endoscopic (43.8% vs 22.7%) and surgical recurrence (20% vs 9.5%) than E−/R− patients (median follow-up, 4.5 years).

Conclusions

Cross-sectional imaging is highly sensitive, but poorly specific, in detecting endoscopic disease activity and postoperative recurrence. Advanced radiographic disease correlates with endoscopic severity. Patients with radiographic activity in the absence of endoscopic recurrence may be at increased risk for future recurrence, and closer monitoring should be considered.

中文翻译：

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克罗恩病术后横断面影像学检查特点及与内镜检查的一致性

背景与目标

术后克罗恩病 (CD) 监测依赖于内窥镜监测。横截面成像的作用尚不清楚。我们评估了横断面肠造影与内镜复发的一致性以及放射线检查对未来 CD 术后复发的预测能力。

方法

我们对患有 CD 的术后成人患者进行了一项多机构回顾性队列研究，这些患者在回盲部切除术后 90 天内分别接受了回肠结肠镜检查和横断面肠造影。影像学研究由盲法 CD 放射科医生专家解读。根据内镜术后复发（E+）（改良Rutgeerts评分≥i2b）或放射学疾病活动度（R+）对患者进行分类，并根据一致性状态进行分组。

结果

共有 216 名 CD 患者接受了配对回肠结肠镜检查和影像学检查。大多数（54.2%）研究之间表现出一致性（34.7% E+/R+；19.4% E−/R−）。多数人（41.7%；n = 90）E-/R+ 不一致。影像学检查内镜术后复发的敏感性较高（89.3%），特异性较低（31.8%）。肠壁增厚、管腔狭窄、肠壁过度增强和影像学病灶长度与内镜下复发相关（所有P < .01）。放射学疾病严重程度与 Rutgeerts 评分的增加相关 ( P < .001)。 与 E-/R 患者相比，E-/R + 患者随后的内镜复发率更快（风险比为 4.16；P = .033），并且随后的内镜镜复发率（43.8% vs 22.7%）和手术复发率（20% vs 9.5%）更高− 患者（中位随访时间，4.5 年）。

结论

横截面成像在检测内镜疾病活动和术后复发方面高度敏感，但特异性较差。晚期放射学疾病与内镜严重程度相关。在没有内镜复发的情况下进行放射学活动的患者未来复发的风险可能会增加，应考虑进行更密切的监测。