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Gastrointestinal Imaging

E2236. Complications of Crohn Disease as Seen on Cross-Sectional Imaging and What It Means for Management

Stinger R1,  Somwaru A2,  Charabaty-Pishvaian A2,  Bayasi M2,  Levy A.2 1. Georgetown University School of Medicine, Washington, DC; 2. MedStar Georgetown University Hospital, Washington, DC

Address correspondence to R. Stinger (rbs52@georgetown.edu)

Background Information: Crohn disease (CD) is a chronic inflammatory process involving the gastrointestinal tract; the inflammation is typically transmural in nature and can affect any portion of the tract from the mouth to the anus. Patients with CD frequently endure relapse and remission of symptoms. It is present among all age groups and various ethnicities, although is more common in white populations. Complications of CD include fulminant active inflammation, fibrostenotic stricture, and penetrating or perforating disease including fistula and abscess. CT and MR enterography (CTE and MRE) are used to characterize the degree of inflammation and associated transmural and extramural disease. Accurate characterization of disease severity and presence of complications is necessary for appropriate management. Management of complications includes endoscopy, surgery, and interventional radiology (IR).

Educational Goals/Teaching Points: Several teaching points will be discussed in this educational exhibit. We will list the strengths and limitations of MRE and CTE in characterizing complications of CD. We will describe how MRE and CTE findings of complications in CD aid in the determination of endoscopic versus surgical management, as well as IR management of abscesses. Lastly, we plan to illustrate specific MRE and CTE findings of complicated CD with correlative endoscopic, surgical, and pathologic photographs.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques: It is important to understand key imaging findings and subsequent management of inflammatory bowel disease complications. Cross-sectional imaging is helpful in cases of fulminant active inflammation that lead to surgery, including those cases of a staged surgical approach. Other issues include fibrostenotic strictures that ultimately undergo endoscopic dilation, surgical excision, and stricturoplasty. Furthermore, MRE and CTE can aid in differentiating operative from nonoperative cases of penetrating and perforating disease. This includes the importance of anatomic fistula locations and other specific imaging characteristics that may lead to a surgical approach; additionally, the presence of abscesses and subsequent management by IR versus a surgical approach.

Conclusion: CTE and MRE have proved useful in the diagnosis and characterization of CD and complications that require endoscopic, surgical, or interventional radiology management.