Evaluation of CT enterography findings for endoscopic complete remission after anti-TNF-α therapy in patients with Crohn’s disease

Abstract

Background

Unnecessary prolonged treatment with biologic agents for Crohn’s disease (CD) patients with endoscopic complete remission (CR) might increase the opportunistic infections.

Purpose

To evaluate computed tomography enterography (CTE) findings obtained on CD patients achieving endoscopic CR after anti-tumor necrosis factor (TNF)-α therapy.

Material and Methods

Thirty-six consecutive patients with CD who had received anti-TNF- α therapy and undergone pre-and post-therapy CTE and ileocolonoscopy were initially enrolled. CTE was performed with a standard-dose enteric-phase scan. Eleven patients were excluded due to a mismatch of follow-up intervals or a long interval (>2 weeks) between CTE and ileocolonoscopy; additionally, five patients were excluded due to surgical intervention during the follow-up period. Therefore, 20 patients finally were analyzed. Two blinded readers evaluated the pre-and post-therapy CTE images by consensus for active inflammation, i.e. mural hyperenhancement, mural thickening (thickness > 3 mm), mural stratification, and increased peri-enteric fat attenuation in the rectum, colon, and terminal ileum. Endoscopic CR indicated mucosal healing identified by ileocolonoscopy and served as the reference standard.

Results

Nine patients with 16 bowel segments showed endoscopic CR. Ten of those segments showed residual abnormalities including mild mural hyperenhancement (9/16, P = 0.03), mild mural thickening (6/16, P < 0.001), and both findings (5/16, P < 0.001) on post-therapy CTE. The non-CR group (11 patients; 17 bowel segments) showed a higher concordance rate with post-therapy CTE (88%, 15/17) than did the CR group (38%, 6/16) (P = 0.004).

Conclusion

Residual mild mural hyperenhancement and mild mural thickening were seen on post-therapy CTE in over half of the bowel segments showing endoscopic CR.