Scientific Session 02 — Gastrointestinal - BowelMonday, May 1, 2017
2946. Survey Practices in Utilization of Imaging Modalities in Crohn Disease
Kordbacheh H, Baliyan V*, Kambadakone A. Massachusetts General Hospital, Boston, United States
Address correspondence to V. Baliyan (VBALIYAN@mgh.harvard.edu)
Objective: The purpose of our study was to perform a survey-based assessment to understand practice preferences for ordering imaging studies and trends in imaging utilization in patients with Crohn disease.
Materials and Methods: In this multiinstitutional survey, a questionnaire was sent to gastroenterologists, pediatricians, gastrointestinal surgeons, emergency physicians, and primary care physicians. The survey questionnaire addressed the experience of referring providers, choice of imaging modality in management of Crohn disease, reasons for choice of imaging modality, and recent trends in imaging utilization.
Results: The response rate was 6.44% (103/1598) with 45.1% of respondents involved in care of patients with Crohn disease for > 10 years. For ordering frequency, 53.2% of respondents reported ordering one imaging examination per patient per year. The most frequent imaging indication was for initial diagnosis (36%), evaluation of acute complications (30.6%), and symptom exacerbation (30.3%). CT or CT enterography was the most preferred imaging examination (94%) followed by MRI or MR enterography (52%). CT was the most preferred modality for acute exacerbation (91.7%), evaluation of Crohn disease in a patient with new symptoms (78%), and evaluation of extraintestinal manifestations (66.7%). In patients without symptoms, MRI was most preferred (47.8%) followed by CT (30.4%), ultrasound (13%), and radiography (8.7%) for disease surveillance. A total of 37.9% of respondents indicated that CT was preferred more often than other imaging studies in the past 5 years, whereas 38.9% reported that MRI was preferred, and 23.2% reported no change. In addition, 40.9% of respondents reported that this change applies to both initial diagnostic work-up and follow-up imaging. According to 60.8% of respondents, patients have no preference for a particular imaging study, but patient request was the most common reason for choosing MRI over CT (26.8%), with fear of harmful effects of radiation being the common factor influencing patient preference (57.6%).
Conclusion: Survey results suggest that CT or CT enterography is still the most frequently used imaging study in patients with Crohn disease but that there is a gradually increasing trend toward MRI or MR enterography predominantly due to patient preference and fear of radiation exposure.