Accuracy of imaging for predicting operative approach in Crohn's disease

British Journal of Surgery, 05/11/2012

Preoperative imaging using CTE or MRE is highly accurate for assessing Crohn's disease lesions before operation, allowing correct prediction of the operative approach.

Methods

  • Patients with Crohn's disease who were scheduled to undergo operation were evaluated before operation using computed tomography enteroclysis (CTE) and magnetic resonance enterography (MRE).
  • Preoperative imaging findings were correlated with intraoperative and pathological findings to estimate the capabilities of preoperative imaging in detecting lesions due to Crohn's disease.
  • The operative approach determined before surgery was compared with the procedure actually performed, which was based on intraoperative findings.

Results

  • Fifty–two patients with Crohn's disease were studied; 26 were evaluated before surgery with CTE and 26 with MRE.
  • Eighty–nine lesions due to Crohn's disease were confirmed surgically (60 small bowel stenoses, 21 fistulas and 8 abscesses).
  • CTE confirmed the presence of 38 of 41 lesions (sensitivity 93 per cent) and MRE 48 of 48 lesions (sensitivity 100 per cent); a correct estimation of the disease with an exact prediction of the operative approach was obtained in 49 (94 per cent) of 52 patients.
  • Discrepant findings between preoperative imaging and operative findings were observed in three patients (6 per cent), who had CTE.

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