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Diagnostic Value of Computed Tomography in Crohn's Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

Authors
 Sunyoung Lee  ;  Byong Duk Ye  ;  Seong Ho Park  ;  Kyung Jin Lee  ;  Ah Young Kim  ;  Jong Seok Lee  ;  Hyun Jin Kim  ;  Suk-Kyun Yang 
Citation
 KOREAN JOURNAL OF RADIOLOGY, Vol.19(6) : 1089-1098, 2018 
Journal Title
 KOREAN JOURNAL OF RADIOLOGY 
ISSN
 1229-6929 
Issue Date
2018
Keywords
Computed tomographic enterography ; Computed tomography ; Crohn's disease ; Diagnostic yield ; Lower gastrointestinal bleeding ; Rebleeding
Abstract
Objective: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. Materials and Methods: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. Results: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041). Conclusion: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.
Files in This Item:
T201804295.pdf Download
DOI
10.3348/kjr.2018.19.6.1089
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Lee, Sunyoung(이선영) ORCID logo https://orcid.org/0000-0002-6893-3136
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/166293
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