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A Pictoral review of active and long-standing Crohn
EP34199
Poster Title: A Pictoral review of active and long-standing Crohn's Disease
Submitted on 22 Oct 2020
Author(s): Afreen Ameer Hussain1, Arafat Muhammed Haris2
Affiliations: Manchester Royal Infirmary, United Kingdom1, Diagnostic Gastro-radiology, Hyderabad India2
This poster was presented at BIR Annual Congress 2020
Poster Views: 90
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Poster Information
Abstract: Learning objectives:
To describe the spectrum of imaging findings of Crohn’s disease and to differentiate active and long standing appearances of Crohn’s disease.
Background:
Crohn disease is a chronic transmural granulomatous inflammation of the bowel wall characterized by waxing and waning course & discontinuous involvement of the gastrointestinal tract. It can affect any part from the oral cavity to anus.
Findings and procedure details:
Bowel wall enhancement is ideally evaluated in the enteric phase and is usually circumferential, most commonly involving the terminal ileum. (Figure 1). Segmental Mural Hyperenhancement is considered to be the earliest & most sensitive sign of active CD (Figures 1 and 2). Submucosal edema leads to wall thickening and is seen as hypodense area on CTE & hyperintense area on T2 WI on MRI. It is a sign of active inflammation. Penetrating Crohn Disease such as sinuses, fistulas, abscesses & inflammatory mass are the major complications in CD & are a sign of active disease. Mesenteric findings associated with CD include peri-enteric edema and/or inflammation, engorged vasa recta, fibrofatty proliferation, mesenteric venous thrombosis and/or occlusion and lymphadenopathy (usually reactive & measure <1.0 cm in short axis diameter). Comb sign is a manifestation due to engorged vasa recta as a result of increase in the vascularity in the mesentery. It is regarded as a specific sign of active inflammation. (Figure 3) Stricture formation can be associated with penetrating disease in the small bowel - usually arise in the mid or proximal aspect of a stricture( Figure 4).
Conclusion
Both CT enterography/ enteroclysis and MR enterography can help identify disease involvement, activity, and extent, along with the presence of complications
Summary: To describe the spectrum of imaging findings of Crohn’s disease and to differentiate active and long standing appearances of Crohn’s disease based on CT findingsReferences: 1. Guglielmo FF, Anupindi SA, Fletcher JG, Al-Hawary MM, Dillman JR, Grand DJ, Bruining DH, Chatterji M, Darge K, Fidler JL, Gandhi NS. Small Bowel Crohn Disease at CT and MR Enterography: Imaging Atlas and Glossary of Terms. RadioGraphics. 2020 Jan 17:190091.
2. Rimola J, Planell N, Rodríguez S, et al. Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 2015;110(3):432–440 [Published correction appears in Am J Gastroenterol 2015;110(3):480.].
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