This is important because promoting situations of complete mucosal healing has been associated with sustained clinical remission, reduced hospitalization rates, and decreased need for surgery [12,13,105]. As with endoscopy, imaging may better direct treatment based on objective findings because it is known that subjective symptomatology and other clinical parameters have shown poor correlation with disease activity [106]. Secondly, when CD strictures are detected, imaging can help determine whether the narrowing is predominantly due to active inflammation or due to fibrosis. This distinction is critical because the former responds to medical interventions, whereas the latter would be better treated surgically. Because of the cost and significant complications of agents such as infliximab, empiric treatment with these agents to make this distinction (ie, does treatment improve the stenosis) is less attractive. CT Abdomen and Pelvis Standard abdomen and pelvis CT with IV contrast with a routine protocol (ie, without oral contrast enterography technique) can detect evidence for active CD. CT with positive luminal contrast can identify wall thickening, luminal narrowing, and adjacent inflammatory changes that may be seen in CD [39]. However, mucosal enhancement is obscured and subtle enhancement may be missed without the bowel optimization present with enterography technique. The decreased performance compared against other modalities with optimized bowel protocol would argue against its use in this clinical variant in which the patient is relatively well and able to tolerate the increased oral contrast volumes. Standard abdomen and pelvis CT without IV contrast is further hampered when evidence of increased vascularity seen with IV contrast use is not available. Crohn Disease CT Enteroclysis CT enteroclysis is a CT-based examination in which a nasoduodenal tube is placed to allow controlled distention of the small bowel. Typically, neutral contrast is infused and IV contrast given.
Crohn Disease. This is important because promoting situations of complete mucosal healing has been associated with sustained clinical remission, reduced hospitalization rates, and decreased need for surgery [12,13,105]. As with endoscopy, imaging may better direct treatment based on objective findings because it is known that subjective symptomatology and other clinical parameters have shown poor correlation with disease activity [106]. Secondly, when CD strictures are detected, imaging can help determine whether the narrowing is predominantly due to active inflammation or due to fibrosis. This distinction is critical because the former responds to medical interventions, whereas the latter would be better treated surgically. Because of the cost and significant complications of agents such as infliximab, empiric treatment with these agents to make this distinction (ie, does treatment improve the stenosis) is less attractive. CT Abdomen and Pelvis Standard abdomen and pelvis CT with IV contrast with a routine protocol (ie, without oral contrast enterography technique) can detect evidence for active CD. CT with positive luminal contrast can identify wall thickening, luminal narrowing, and adjacent inflammatory changes that may be seen in CD [39]. However, mucosal enhancement is obscured and subtle enhancement may be missed without the bowel optimization present with enterography technique. The decreased performance compared against other modalities with optimized bowel protocol would argue against its use in this clinical variant in which the patient is relatively well and able to tolerate the increased oral contrast volumes. Standard abdomen and pelvis CT without IV contrast is further hampered when evidence of increased vascularity seen with IV contrast use is not available. Crohn Disease CT Enteroclysis CT enteroclysis is a CT-based examination in which a nasoduodenal tube is placed to allow controlled distention of the small bowel. Typically, neutral contrast is infused and IV contrast given.