Systematic reporting of computed tomography enterography/enteroclysis as an aid to reduce diagnostic dilemma when differentiating between intestinal tuberculosis and Crohn's disease: A prospective study at a tertiary care hospital

Background and Aim Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characte...

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Bibliographic Details
Published in:JGH open 2021-02, Vol.5 (2), p.180-189
Main Authors: Israrahmed, Amrin, Yadav, Rajanikant R, Yadav, Geeta, Alpana, Helavar, Rajesh V, Rai, Praveer, Jain, Manoj Kumar, Gupta, Archna
Format: Article
Language:English
Subjects:
Abdomen
Biopsy
computed tomography enteroclysis
computed tomography enterography
Consent
Contrast agents
Crohn's disease
Endoscopy
gastrointestinal tuberculosis
Granulomas
Histopathology
Leading
Lymphatic system
Polyethylene glycol
Tuberculosis
Ulcers
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Summary:Background and Aim Crohn's disease (CD) and intestinal tuberculosis (ITB) have similar symptomatology and overlapping features on imaging, endoscopy, and histopathology. It is important to differentiate ITB from CD to initiate correct medical management. This prospective study aimed to characterize imaging features on computed tomography enteroclysis/enterography (CTE) that help in differentiating ITB from CD. Methods A total of 300 consecutive patients who underwent CTE with the suspicion of small bowel diseases were evaluated. CTE findings were documented on a detailed “CTE case record form” and were correlated with other investigations like endoscopy, histopathological and microbiological examination, and improvement on empirical therapy to arrive at a final diagnosis. Only confirmed cases of ITB/CD were included for further analysis. Results Final diagnoses revealed that 61 patients had ITB, 24 had CD, 90 patients had a final diagnosis not related to ITB/CD, and 125 had no bowel‐related diseases. The sensitivity of CTE (ITB vs CD, 90.2 vs 91.6%) was higher than the sensitivity of ileocolonoscopy (ITB vs CD, 87 vs 83.3%). A homogenous pattern of bowel wall thickening and confluent bowel involvement were significantly more common in ITB. Stratified bowel wall thickening with mucosal hyperenhancement, skip lesions in the bowel, and a comb sign were significantly more common in CD. Stratified bowel wall enhancement with an intervening layer of fat was specifically (P 
ISSN:2397-9070
2397-9070
DOI:10.1002/jgh3.12478