Indian guidelines on imaging of the small intestine in Crohn’s disease: A joint Indian Society of Gastroenterology and Indian Radiology and Imaging Association consensus statement

Abstract

The Indian Society of Gastroenterology (ISG) Task Force on Inflammatory Bowel Disease and the Indian Radiological and Imaging Association (IRIA) developed combined ISG-IRIA evidence-based best-practice guidelines for imaging of the small intestine in patients suspected to have or having Crohn’s disease. The 29 consensus statements, developed through a modified Delphi process, are intended to serve as reference for teaching, clinical practice, and research.

Keywords

Biologics - computerized tomography enterography - enterography - imaging - inflammatory bowel disease - magnetic resonance imaging - tuberculosis

Publication History

Article published online:
22 July 2021

• References

• 1 Ramakrishna BS, Makharia GK, Abraham P, Ghoshal UC, Jayanthi V, Agarwal BK. et al. Indian Society of Gastroenterology consensus on ulcerative colitis. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2012; 31: 307-23
• 2 Ramakrishna BS, Makharia GK, Ahuja V, Ghoshal UC, Jayanthi V, Perakath B. et al. Indian Society of Gastroenterology consensus statements on Crohn’s disease in India. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2015; 34: 3-22
• 3 Kedia S, Sharma R, Makharia GK, Ahuja V, Desai D, Kandasamy D. et al. Imaging of the small intestine in Crohn’s disease: Joint position statement of the Indian Society of Gastroenterology and Indian Radiological and Imaging Association. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2017; 36: 487-508
• 4 Linstone H, Turoff M. The Delphi method: Techniques and application.
• 5 The periodic health examination: 2. 1984 update. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 1984; 130: 1278-85
• 6 Makharia GK, Ramakrishna BS, Abraham P, Choudhuri G, Misra SP, Ahuja V. et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2012; 31: 299-306
• 7 Magro F, Gionchetti P, Eliakim R, Ardizzone S, Armuzzi A, Barreiro-de Acosta M. et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: Definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohns Colitis 2017; 11: 649-70
• 8 Yang DH, Keum B, Jeen YT. Capsule endoscopy for Crohn’s disease: Current status of diagnosis and management. Gastroenterol Res Pract 2016; 2016: 8236367
• 9 Kelvin FM, Gedgaudas RK. Radiologic diagnosis of Crohn disease (with emphasis on its early manifestations). Crit Rev Diagn Imaging 1981; 16: 43-91
• 10 Nolan DJ. Radiology of Crohn’s disease of the small intestine: A review. J R Soc Med 1981; 74: 294-300
• 11 Bernstein CN, Boult IF, Greenberg HM, van der Putten W, Duffy G, Grahame GR. A prospective randomized comparison between small bowel enteroclysis and small bowel follow-through in Crohn’s disease. Gastroenterology 1997; 113: 390-8
• 12 Bernstein CN, Greenberg H, Boult I, Chubey S, Leblanc C, Ryner L. A prospective comparison study of MRI versus small bowel follow-through in recurrent Crohn’s disease. Am J Gastroenterol 2005; 100: 2493-502
• 13 Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, De Petris G. et al. Crohn disease of the small bowel: Preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 2006; 238: 128-34
• 14 Lee SS, Kim AY, Yang S-K, Chung J-W, Kim SY, Park SH. et al. Crohn disease of the small bowel: Comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques 1. Radiology 2009; 251: 751-61
• 15 Albert JG, Martiny F, Krummenerl A, Stock K, Lesske J, Göbel CM. et al. Diagnosis of small bowel Crohn’s disease: A prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut 2005; 54: 1721-7
• 16 Umschaden HW, Szolar D, Gasser J, Umschaden M, Haselbach H. Small-bowel disease: Comparison of MR enteroclysis images with conventional enteroclysis and surgical findings. Radiology 2000; 215: 717-25
• 17 Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, Papamastorakis G, Prassopoulos P, Roussomoustakaki M. Assessment of Crohn’s disease activity in the small bowel with MR and conventional enteroclysis: Preliminary results. Eur Radiol 2004; 14: 1017-24
• 18 Masselli G, Casciani E, Polettini E, Lanciotti S, Bertini L, Gualdi G. Assessment of Crohn’s disease in the small bowel: Prospective comparison of magnetic resonance enteroclysis with conventional enteroclysis. Eur Radiol 2006; 16: 2817-27
• 19 Wold PB, Fletcher JG, Johnson CD, Sandborn WJ. Assessment of small bowel Crohn disease: Noninvasive peroral CT enterography compared with other imaging methods and endoscopy--feasibility study. Radiology 2003; 229: 275-81
• 20 Ryan ER, Heaslip ISE. Magnetic resonance enteroclysis compared with conventional enteroclysis and computed tomography enteroclysis: A critically appraised topic. Abdom Imaging 2008; 33: 34-7
• 21 Reittner P, Goritschnig T, Petritsch W, Doerfler O, Preidler KW, Hinterleitner T. et al. Multiplanar spiral CT enterography in patients with Crohn’s disease using a negative oral contrast material: Initial results of a noninvasive imaging approach. Eur Radiol 2002; 12: 2253-7
• 22 Horsthuis K, Lavini C, Stoker J. MRI in Crohn’s disease. J Magn Reson Imaging JMRI 2005; 22: 1-12
• 23 Negaard A, Paulsen V, Sandvik L, Berstad AE, Borthne A, Try K. et al. A prospective randomized comparison between two MRI studies of the small bowel in Crohn’s disease, the oral contrast method and MR enteroclysis. Eur Radiol 2007; 17: 2294-301
• 24 Schreyer AG, Geissler A, Albrich H, Schölmerich J, Feuerbach S, Rogler G. et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2004; 2: 491-7
• 25 Masselli G, Casciani E, Polettini E, Gualdi G. Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease. Eur Radiol 2008; 18: 438-47
• 26 Dave-Verma H, Moore S, Singh A, Martins N, Zawacki J. Computed tomographic enterography and enteroclysis: Pearls and pitfalls. Curr Probl Diagn Radiol 2008; 37: 279-87
• 27 Paparo F, Garlaschi A, Biscaldi E, Bacigalupo L, Cevasco L, Rollandi GA. Computed tomography of the bowel: A prospective comparison study between four techniques. Eur J Radiol 2013; 82: e1-10
• 28 Minordi LM, Vecchioli A, Mirk P, Bonomo L. CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 2011; 84: 112-9
• 29 Qi F, Jun S, Qi QY, Chen PJ, Chuan GX, Jiong Z. et al. Utility of the diffusion-weighted imaging for activity evaluation in Crohn’s disease patients underwent magnetic resonance enterography. BMC Gastroenterol 2015; 15: 12
• 30 Kim KJ, Lee Y, Park SH, Kang BK, Seo N, Yang SK. et al. Diffusion-weighted MR enterography for evaluating Crohn’s disease: How does it add diagnostically to conventional MR enterography?. Inflamm Bowel Dis 2015; 21: 101-9
• 31 Choi SH, Kim KW, Lee JY, Kim KJ, Park SH. Diffusion-weighted magnetic resonance enterography for evaluating bowel inflammation in Crohn’s disease: A systematic review and meta-analysis. Inflamm Bowel Dis 2016; 22: 669-79
• 32 Grand DJ, Beland MD, Machan JT, Mayo-Smith WW. Detection of Crohn’s disease: Comparison of CT and MR enterography without anti-peristaltic agents performed on the same day. Eur J Radiol 2012; 81: 1735-41
• 33 Jensen MD, Kjeldsen J, Rafaelsen SR, Nathan T. Diagnostic accuracies of MR enterography and CT enterography in symptomatic Crohn’s disease. Scand J Gastroenterol 2011; 46: 1449-57
• 34 Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM. et al. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn’s disease. AJR Am J Roentgenol 2009; 193: 113-21
• 35 Qiu Y, Mao R, Chen B-L, Li X-H, He Y, Zeng Z-R. et al. Systematic review with meta-analysis: Magnetic resonance enterography vs. computed tomography enterography for evaluating disease activity in small bowel Crohn’s disease. Aliment Pharmacol Ther 2014; 40: 134-46
• 36 Amitai MM, Raviv-Zilka L, Hertz M, Erlich Z, Konen E, Ben-Horin S. et al. Main imaging features of Crohn’s disease: Agreement between MR-enterography and CT-enterography. Isr Med Assoc J IMAJ 2015; 17: 293-7
• 37 Ippolito D, Invernizzi F, Galimberti S, Panelli MR, Sironi S. MR enterography with polyethylene glycol as oral contrast medium in the follow-up of patients with Crohn disease: Comparison with CT enterography. Abdom Imaging 2010; 35: 563-70
• 38 Quencer KB, Nimkin K, Mino-Kenudson M, Gee MS. Detecting active inflammation and fibrosis in pediatric Crohn’s disease: Prospective evaluation of MR-E and CT-E. Abdom Imaging 2013; 38: 705-13
• 39 Fiorino G, Bonifacio C, Peyrin-Biroulet L, Minuti F, Repici A, Spinelli A. et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis 2011; 17: 1073-80
• 40 Jensen MD, Ormstrup T, Vagn-Hansen C, Østergaard L, Rafaelsen SR. Interobserver and intermodality agreement for detection of small bowel Crohn’s disease with MR enterography and CT enterography. Inflamm Bowel Dis 2011; 17: 1081-8
• 41 Masselli G, Gualdi G. CT and MR enterography in evaluating small bowel diseases: When to use which modality?. Abdom Imaging 2013; 38: 249-59
• 42 Kim AY. Role of computed tomography enterography/magnetic resonance enterography: Is it in prime time?. Clin Endosc 2012; 45: 269-73
• 43 Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R. et al. Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009; 251: 175-84
• 44 Kotlyar DS, Lewis JD, Beaugerie L, Tierney A, Brensinger CM, Gisbert JP. et al. Risk of lymphoma in patients with inflammatory bowel disease treated with azathioprine and 6-mercaptopurine: A meta-analysis. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2015; 13: 847-858.e4
• 45 Kroeker KI, Lam S, Birchall I, Fedorak RN. Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: A five-year study. J Clin Gastroenterol 2011; 45: 34-9
• 46 Sauer CG, Kugathasan S, Martin DR, Applegate KE. Medical radiation exposure in children with inflammatory bowel disease estimates high cumulative doses. Inflamm Bowel Dis 2011; 17: 2326-32
• 47 Peloquin JM, Pardi DS, Sandborn WJ, Fletcher JG, McCollough CH, Schueler BA. et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol 2008; 103: 2015-22
• 48 Palmer L, Herfarth H, Porter CQ, Fordham LA, Sandler RS, Kappelman MD. Diagnostic ionizing radiation exposure in a population-based sample of children with inflammatory bowel diseases. Am J Gastroenterol 2009; 104: 2816-23
• 49 Englund H, Lidén K K, Lind T, Sundström T, Karling P. Radiation exposure in patients with inflammatory bowel disease and irritable bowel syndrome in the years 2001-2011. Scand J Gastroenterol 2017; 52: 300-5
• 50 Masselli G, Mastroiacovo I, De Marco E, Francione G, Casciani E, Polettini E. et al. Current tecniques and new perpectives research of magnetic resonance enterography in pediatric Crohn’s disease. World J Radiol 2016; 8: 668-82
• 51 Schreyer AG, Hoffstetter P, Daneschnejad M, Jung E-M, Pawlik M, Friedrich C. et al. Comparison of conventional abdominal CT with MR-enterography in patients with active Crohn’s disease and acute abdominal pain. Acad Radiol 2010; 17: 352-7
• 52 Greenup A-J, Bressler B, Rosenfeld G. Medical imaging in small bowel Crohn’s disease-computer tomography enterography, magnetic resonance enterography, and ultrasound: “Which one is the best for what?”. Inflamm Bowel Dis 2016; 22: 1246-61
• 53 Das K, Ghoshal UC, Dhali GK, Benjamin J, Ahuja V, Makharia GK. Crohn’s disease in India: A multicenter study from a country where tuberculosis is endemic. Dig Dis Sci 2009; 54: 1099-107
• 54 Silverberg MS, Satsangi J, Ahmad T, Arnott IDR, Bernstein CN, Brant SR. et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: Report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol J Can Gastroenterol 2005; 19: 5A-36A
• 55 Vermeire S, Van Assche G, Rutgeerts P. Classification of inflammatory bowel disease: The old and the new. Curr Opin Gastroenterol 2012; 28: 321-6
• 56 Ooi CJ, Makharia GK, Hilmi I, Gibson PR, Fock KM, Ahuja V. et al. Asia Pacific consensus statements on Crohn’s disease. Part 1: Definition, diagnosis, and epidemiology: (Asia Pacific Crohn’s Disease Consensus--Part 1). J Gastroenterol Hepatol 2016; 31: 45-55
• 57 Ghoshal UC, Lakshmi CP, Kumar S, Das K, Misra A, Rai P. et al. Capsule endoscopy for obscure gastrointestinal bleeding in the tropics: Report from India. Dig Endosc Off J Jpn Gastroenterol Endosc Soc 2011; 23: 17-23
• 58 Chu Y, Wu S, Qian Y, Wang Q, Li J, Tang Y. et al. Complimentary imaging modalities for investigating obscure gastrointestinal bleeding: Capsule endoscopy, double-balloon enteroscopy, and computed tomographic enterography. Gastroenterol Res Pract 2016; 2016: 8367519
• 59 Triester SL, Leighton JA, Leontiadis GI, Gurudu SR, Fleischer DE, Hara AK. et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease. Am J Gastroenterol 2006; 101: 954-64
• 60 Ma JJ, Wang Y, Xu XM, Su JW, Jiang WY, Jiang JX. et al. Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?. World J Gastroenterol 2016; 22: 10625-30
• 61 Annunziata ML, Caviglia R, Papparella LG, Cicala M. Upper gastrointestinal involvement of Crohn’s disease: A prospective study on the role of upper endoscopy in the diagnostic work-up. Dig Dis Sci 2012; 57: 1618-23
• 62 Hummel TZ, ten Kate FJW, Reitsma JB, Benninga MA, Kindermann A. Additional value of upper GI tract endoscopy in the diagnostic assessment of childhood IBD. J Pediatr Gastroenterol Nutr 2012; 54: 753-7
• 63 Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976; 63: 1-12
• 64 Schwartz DA, Wiersema MJ, Dudiak KM, Fletcher JG, Clain JE, Tremaine WJ. et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064-72
• 65 Kim DH, Carucci LR, Baker ME, Cash BD, Dillman JR, Feig BW. et al. ACR appropriateness criteria Crohn disease. J Am Coll Radiol JACR 2015; 12: 1048-57.e4
• 66 Madureira AJ. The comb sign. Radiology 2004; 230: 783-4
• 67 Booya F, Fletcher JG, Huprich JE, Barlow JM, Johnson CD, Fidler JL. et al. Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology 2006; 241: 787-95
• 68 Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM. et al. Crohn disease: Mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation. Radiology 2006; 238: 505-16
• 69 Colombel JF, Solem CA, Sandborn WJ, Booya F, Loftus EV, Harmsen WS. et al. Quantitative measurement and visual assessment of ileal Crohn’s disease activity by computed tomography enterography: Correlation with endoscopic severity and C reactive protein. Gut 2006; 55: 1561-7
• 70 Wu YW, Tao XF, Tang YH, Hao NX, Miao F. Quantitative measures of comb sign in Crohn’s disease: Correlation with disease activity and laboratory indications. Abdom Imaging 2012; 37: 350-8
• 71 Lo Re G, Cappello M, Tudisca C, Galia M, Randazzo C, Craxì A. et al. CT enterography as a powerful tool for the evaluation of inflammatory activity in Crohn’s disease: Relationship of CT findings with CDAI and acute-phase reactants. Radiol Med (Torino) 2014; 119: 658-66
• 72 Puylaert CAJ, Tielbeek JAW, Bipat S, Stoker J. Grading of Crohn’s disease activity using CT, MRI, US and scintigraphy: A meta-analysis. Eur Radiol 2015; 25: 3295-313
• 73 Church PC, Turner D, Feldman BM, Walters TD, Greer ML, Amitai MM. et al. Systematic review with meta-analysis: Magnetic resonance enterography signs for the detection of inflammation and intestinal damage in Crohn’s disease. Aliment Pharmacol Ther 2015; 41: 153-66
• 74 Westerland O, Griffin N. Magnetic Resonance Enterography in Crohn’s Disease. Semin Ultrasound CT MR 2016; 37: 282-91
• 75 Rimola J, Rodriguez S, García-Bosch O, Ordás I, Ayala E, Aceituno M. et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn’s disease. Gut 2009; 58: 1113-20
• 76 Buisson A, Joubert A, Montoriol P-F, Da Ines D, Ines DD, Hordonneau C. et al. Diffusion-weighted magnetic resonance imaging for detecting and assessing ileal inflammation in Crohn’s disease. Aliment Pharmacol Ther 2013; 37: 537-45
• 77 Hordonneau C, Buisson A, Scanzi J, Goutorbe F, Pereira B, Borderon C. et al. Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: Validation of quantitative index of activity. Am J Gastroenterol 2014; 109: 89-98
• 78 Tolan DJM, Greenhalgh R, Zealley IA, Halligan S, Taylor SA. MR enterographic manifestations of small bowel Crohn disease. Radiogr Rev Publ Radiol Soc N Am Inc 2010; 30: 367-84
• 79 Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J. et al. Magnetic resonance imaging for evaluation of Crohn’s disease: Validation of parameters of severity and quantitative index of activity. Inflamm Bowel Dis 2011; 17: 1759-68
• 80 Kim JS, Jang HY, Park SH, Kim KJ, Han K, Yang SK. et al. MR enterography assessment of bowel inflammation severity in Crohn disease using the MR index of activity score: Modifying roles of DWI and effects of contrast phases. AJR Am J Roentgenol 2017; 208: 1022-9
• 81 Annese V, Daperno M, Rutter MD, Amiot A, Bossuyt P, East J. et al. European evidence based consensus for endoscopy in inflammatory bowel disease. J Crohns Colitis 2013; 7: 982-1018
• 82 Cosnes J, Cattan S, Blain A, Beaugerie L, Carbonnel F, Parc R. et al. Long-term evolution of disease behavior of Crohn’s disease. Inflamm Bowel Dis 2002; 8: 244-50
• 83 Chan G, Fefferman DS, Farrell RJ. Endoscopic assessment of inflammatory bowel disease: Colonoscopy/esophagogastroduodenoscopy. Gastroenterol Clin North Am 2012; 41: 271-90
• 84 Huang LC, Merchea A. Dysplasia and cancer in inflammatory bowel disease. Surg Clin North Am 2017; 97: 627-39
• 85 Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: A systematic review. Gut 2013; 62: 1072-84
• 86 Rimola J, Planell N, Rodríguez S, Delgado S, Ordás I, Ramírez-Morros A. et al. Characterization of inflammation and fibrosis in Crohn’s disease lesions by magnetic resonance imaging. Am J Gastroenterol 2015; 110: 432-40
• 87 Maccioni F, Staltari I, Pino AR, Tiberti A. Value of T2-weighted magnetic resonance imaging in the assessment of wall inflammation and fibrosis in Crohn’s disease. Abdom Imaging 2012; 37: 944-57
• 88 Tielbeek JAW, Ziech MLW, Li Z, Lavini C, Bipat S, Bemelman WA. et al. Evaluation of conventional, dynamic contrast enhanced and diffusion weighted MRI for quantitative Crohn’s disease assessment with histopathology of surgical specimens. Eur Radiol 2014; 24: 619-29
• 89 Moy MP, Kaplan JL, Moran CJ, Winter HS, Gee MS. MR Enterographic findings as biomarkers of mucosal healing in young patients with Crohn disease. AJR Am J Roentgenol 2016; 207: 896-902
• 90 Fornasa F, Benassuti C, Benazzato L. Role of magnetic resonance enterography in differentiating between fibrotic and active inflammatory small bowel stenosis in patients with Crohn’s disease. J Clin Imaging Sci 2011; 1: 35
• 91 Pazahr S, Blume I, Frei P, Chuck N, Nanz D, Rogler G. et al. Magnetization transfer for the assessment of bowel fibrosis in patients with Crohn’s disease: Initial experience. Magma N Y N 2013; 26: 291-301
• 92 Panés J, Bouzas R, Chaparro M, García-Sánchez V, Gisbert JP, Martínez de Guereñu B. et al. Systematic review: The use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther 2011; 34: 125-45
• 93 Malagò R, D’Onofrio M, Mantovani W, D’Alpaos G, Foti G, Pezzato A. et al. Contrast-enhanced ultrasonography (CEUS) vs. MRI of the small bowel in the evaluation of Crohn’s disease activity. Radiol Med (Torino) 2012; 117: 268-81
• 94 Ripollés T, Rausell N, Paredes JM, Grau E, Martínez MJ, Vizuete J. Effectiveness of contrast-enhanced ultrasound for characterisation of intestinal inflammation in Crohn’s disease: A comparison with surgical histopathology analysis. J Crohns Colitis 2013; 7: 120-8
• 95 Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J. Behaviour of Crohn’s disease according to the Vienna classification: Changing pattern over the course of the disease. Gut 2001; 49: 777-82
• 96 Booya F, Akram S, Fletcher JG, Huprich JE, Johnson CD, Fidler JL. et al. CT enterography and fistulizing Crohn’s disease: Clinical benefit and radiographic findings. Abdom Imaging 2009; 34: 467-75
• 97 Leardi S, Simi M, Verde B, Pietroletti R, Risetti A, Aloisio F. et al. Diagnostic and therapeutic problems of non perianal fistulas and abscesses in Crohn’s disease. Ital J Surg Sci 1988; 18: 247-52
• 98 Galia M, Agnello F, La Grutta L, Lo Re G, Cabibbo G, Grassedonio E. et al. Computed tomography of bowel obstruction: Tricks of the trade. Expert Rev Gastroenterol Hepatol 2015; 9: 1115-25
• 99 Smida M, Miloudi N, Hefaiedh R, Zaibi R. Emergency surgery for Crohn’s disease. Tunis Med 2016; 94: 210-5
• 100 Canavan C, Abrams KR, Mayberry J. Meta-analysis: Colorectal and small bowel cancer risk in patients with Crohn’s disease. Aliment Pharmacol Ther 2006; 23: 1097-104
• 101 Gionchetti P, Dignass A, Danese S, Magro Dias FJ, Rogler G, Lakatos PL. et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 2: Surgical management and special situations. J Crohns Colitis 2017; 11: 135-49
• 102 Pesce Lamas Constantino C, Souza Rodrigues R, Araujo Oliveira Neto J, Marchiori E, Eiras Araujo AL, Perez R de M. et al. Computed tomography and magnetic resonance enterography findings in Crohn’s disease: What does the clinician need to know from the radiologist?. Can Assoc Radiol J J Assoc Can Radiol 2014; 65: 42-51
• 103 Maconi G, Sampietro GM, Parente F, Pompili G, Russo A, Cristaldi M. et al. Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: A prospective comparative study. Am J Gastroenterol 2003; 98: 1545-55
• 104 Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO. et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: Diagnosis and medical management. J Crohns Colitis 2017; 11: 3-25
• 105 Hellers G, Bergstrand O, Ewerth S, Holmström B. Occurrence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 1980; 21: 525-7
• 106 Panes J, Bouhnik Y, Reinisch W, Stoker J, Taylor SA, Baumgart DC. et al. Imaging techniques for assessment of inflammatory bowel disease: Joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7: 556-85
• 107 Shenoy-Bhangle A, Nimkin K, Goldner D, Bradley WF, Israel EJ, Gee MS. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults. Pediatr Radiol 2014; 44: 23-9
• 108 Siddiqui MRS, Ashrafian H, Tozer P, Daulatzai N, Burling D, Hart A. et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment. Dis Colon Rectum 2012; 55: 576-85
• 109 Maconi G, Tonolini M, Monteleone M, Bezzio C, Furfaro F, Villa C. et al. Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohn’s disease. Inflamm Bowel Dis 2013; 19: 2737-43
• 110 Ng SC, Plamondon S, Gupta A, Burling D, Swatton A, Vaizey CJ. et al. Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn’s perineal fistulas. Am J Gastroenterol 2009; 104: 2973-86
• 111 Van Assche G, Vanbeckevoort D, Bielen D, Coremans G, Aerden I, Noman M. et al. Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 2003; 98: 332-9
• 112 Karmiris K, Bielen D, Vanbeckevoort D, Vermeire S, Coremans G, Rutgeerts P. et al. Long-term monitoring of infliximab therapy for perianal fistulizing Crohn’s disease by using magnetic resonance imaging. Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc 2011; 9: 130-6
• 113 Schnitzler F, Fidder H, Ferrante M, Noman M, Arijs I, Van Assche G. et al. Mucosal healing predicts long-term outcome of maintenance therapy with infliximab in Crohn’s disease. Inflamm Bowel Dis 2009; 15: 1295-301
• 114 Baert F, Moortgat L, Van Assche G, Caenepeel P, Vergauwe P, De Vos M. et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn’s disease. Gastroenterology 2010; 138: 463-8
• 115 Benitez J-M, Meuwis M-A, Reenaers C, Van Kemseke C, Meunier P, Louis E. Role of endoscopy, cross-sectional imaging and biomarkers in Crohn’s disease monitoring. Gut 2013; 62: 1806-16
• 116 Horsthuis K, Bipat S, Bennink RJ, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: Meta-analysis of prospective studies. Radiology 2008; 247: 64-79
• 117 Serafin Z, Białecki M, Białecka A, Sconfienza LM, Kłopocka M. Contrast-enhanced ultrasound for detection of Crohn’s disease activity: Systematic review and meta-analysis. J Crohns Colitis 2016; 10: 354-62
• 118 Gallego Ojea JC, Echarri Piudo AI, Porta Vila A. [Crohn’s disease: The usefulness of MR enterography in the detection of recurrence after surgery]. Radiologia 2011; 53: 552-9
• 119 Sailer J, Peloschek P, Reinisch W, Vogelsang H, Turetschek K, Schima W. Anastomotic recurrence of Crohn’s disease after ileocolic resection: Comparison of MR enteroclysis with endoscopy. Eur Radiol 2008; 18: 2512-21
• 120 Mao R, Gao X, Zhu Z, Feng S, Chen B, He Y. et al. CT enterography in evaluating postoperative recurrence of Crohn’s disease after ileocolic resection: Complementary role to endoscopy. Inflamm Bowel Dis 2013; 19: 977-82
• 121 Getahun H, Matteelli A, Chaisson RE, Raviglione M. Latent Mycobacterium tuberculosis infection. N Engl J Med 2015; 372: 2127-35
• 122 Wong SH, Ip M, Tang W, Lin Z, Kee C, Hung E. et al. Performance of interferon-gamma release assay for tuberculosis screening in inflammatory bowel disease patients. Inflamm Bowel Dis 2014; 20: 2067-72
• 123 Papay P, Eser A, Winkler S, Frantal S, Primas C, Miehsler W. et al. Factors impacting the results of interferon-γ release assay and tuberculin skin test in routine screening for latent tuberculosis in patients with inflammatory bowel diseases. Inflamm Bowel Dis 2011; 17: 84-90
• 124 Andrisani G, Armuzzi A, Papa A, Marzo M, Felice C, Pugliese D. et al. Comparison of Quantiferon-TB Gold versus tuberculin skin test for tuberculosis screening in inflammatory bowel disease patients. J Gastrointest Liver Dis JGLD 2013; 22: 21-5
• 125 Abitbol Y, Laharie D, Cosnes J, Allez M, Nancey S, Amiot A. et al. Negative screening does not rule out the risk of tuberculosis in patients with inflammatory bowel disease undergoing anti-TNF treatment: A descriptive study on the GETAID cohort. J Crohns Colitis 2016; 10: 1179-85
• 126 Debeuckelaere C, De Munter P, Van Bleyenbergh P, De Wever W, Van Assche G, Rutgeerts P. et al. Tuberculosis infection following anti-TNF therapy in inflammatory bowel disease, despite negative screening. J Crohns Colitis 2014; 8: 550-7
• 127 Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD. et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med 2001; 345: 1098-104
• 128 Piccazzo R, Paparo F, Garlaschi G. Diagnostic accuracy of chest radiography for the diagnosis of tuberculosis (TB) and its role in the detection of latent TB infection: A systematic review. J Rheumatol Suppl 2014; 91: 32-40
• 129 Lyu J, Lee SG, Hwang S, Lee SO, Cho OH, Chae EJ. et al. Chest computed tomography is more likely to show latent tuberculosis foci than simple chest radiography in liver transplant candidates. Liver Transplant Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 2011; 17: 963-8
• 130 Hirama T, Hagiwara K, Kanazawa M. Tuberculosis screening programme using the QuantiFERON-TB Gold test and chest computed tomography for healthcare workers accidentally exposed to patients with tuberculosis. J Hosp Infect 2011; 77: 257-62
• 131 Song DJ, Tong JL, Peng JC, Cai CW, Xu XT, Zhu MM. et al. Tuberculosis screening using IGRA and chest computed tomography in patients with inflammatory bowel disease: A retrospective study. J Dig Dis 2017; 18: 23-30
• 132 Makharia GK, Srivastava S, Das P, Goswami P, Singh U, Tripathi M. et al. Clinical, endoscopic, and histological differentiations between Crohn’s disease and intestinal tuberculosis. Am J Gastroenterol 2010; 105: 642-51
• 133 Yu H, Liu Y, Wang Y, Peng L, Li A, Zhang Y. Clinical, endoscopic and histological differentiations between Crohn’s disease and intestinal tuberculosis. Digestion 2012; 85: 202-9
• 134 Lee YJ, Yang S-K, Byeon J-S, Myung S-J, Chang H-S, Hong S-S. et al. Analysis of colonoscopic findings in the differential diagnosis between intestinal tuberculosis and Crohn’s disease. Endoscopy 2006; 38: 592-7
• 135 Pulimood AB, Peter S, Rook GWA, Donoghue HD. In situ PCR for Mycobacterium tuberculosis in endoscopic mucosal biopsy specimens of intestinal tuberculosis and Crohn disease. Am J Clin Pathol 2008; 129: 846-51
• 136 Kirsch R, Pentecost M, Hall P de M, Epstein DP, Watermeyer G, Friederich PW. Role of colonoscopic biopsy in distinguishing between Crohn’s disease and intestinal tuberculosis. J Clin Pathol 2006; 59: 840-4
• 137 Jin XJ, Kim JM, Kim HK, Kim L, Choi SJ, Park IS. et al. Histopathology and TB-PCR kit analysis in differentiating the diagnosis of intestinal tuberculosis and Crohn’s disease. World J Gastroenterol 2010; 16: 2496-503
• 138 Amarapurkar DN, Patel ND, Rane PS. Diagnosis of Crohn’s disease in India where tuberculosis is widely prevalent. World J Gastroenterol 2008; 14: 741-6
• 139 Logan VS. Anorectal tuberculosis. Proc R Soc Med 1969; 62: 1227-30
• 140 Kedia S, Sharma R, Nagi B, Mouli VP, Aananthakrishnan A, Dhingra R. et al. Computerized tomography-based predictive model for differentiation of Crohn’s disease from intestinal tuberculosis. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2015; 34: 135-43
• 141 Mao R, Liao W, He Y, Ouyang C, Zhu Z, Yu C. et al. Computed tomographic enterography adds value to colonoscopy in differentiating Crohn’s disease from intestinal tuberculosis: A potential diagnostic algorithm. Endoscopy 2015; 47: 322-9
• 142 Zhao X-S, Wang Z-T, Wu Z-Y, Yin Q-H, Zhong J, Miao F. et al. Differentiation of Crohn’s disease from intestinal tuberculosis by clinical and CT enterographic models. Inflamm Bowel Dis 2014; 20: 916-25
• 143 Krishna S, Kalra N, Singh P, Kochhar R, Gupta R, Singh R. et al. Small-bowel tuberculosis: A comparative study of MR enterography and small-bowel follow-through. AJR Am J Roentgenol 2016; 207: 571-7
• 144 Zhao J, Cui M-Y, Chan T, Mao R, Luo Y, Barua I. et al. Evaluation of intestinal tuberculosis by multi-slice computed tomography enterography. BMC Infect Dis 2015; 15: 577
• 145 Bhargava S, Kumar P, Bhargava SK. Role of multislice CT in abdominal tuberculosis. J Int Med Sci Acad 2013; 26: 47-50
• 146 Gourtsoyianni S, Papanikolaou N, Amanakis E, Bourikas L, Roussomoustakaki M, Grammatikakis J. et al. Crohn’s disease lymphadenopathy: MR imaging findings. Eur J Radiol 2009; 69: 425-8
• 147 Burrill J, Williams CJ, Bain G, Conder G, Hine AL, Misra RR. Tuberculosis: A radiologic review. Radiogr Rev Publ Radiol Soc N Am Inc 2007; 27: 1255-73
• 148 Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995; 33: 691-705
• 149 Kedia S, Sharma R, Sreenivas V, Madhusudhan KS, Sharma V, Bopanna S. et al. Accuracy of computed tomographic features in differentiating intestinal tuberculosis from Crohn’s disease: A systematic review with meta-analysis. Intest Res 2017; 15: 149-59
• 150 Park YH, Chung W-S, Lim JS, Park SJ, Cheon JH, Kim TI. et al. Diagnostic role of computed tomographic enterography differentiating crohn disease from intestinal tuberculosis. J Comput Assist Tomogr 2013; 37: 834-9
• 151 Limsrivilai J, Shreiner AB, Pongpaibul A, Laohapand C, Boonanuwat R, Pausawasdi N. et al. Meta-analytic bayesian model for differentiating intestinal tuberculosis from Crohn’s disease. Am J Gastroenterol 2017; 112: 415-27
• 152 Yadav DP, Madhusudhan KS, Kedia S, Sharma R, Pratap Mouli V, Bopanna S. et al. Development and validation of visceral fat quantification as a surrogate marker for differentiation of Crohn’s disease and intestinal tuberculosis. J Gastroenterol Hepatol 2017; 32: 420-6
• 153 Ko JK, Lee HL, Kim JO, Song SY, Lee KN, Jun DW. et al. Visceral fat as a useful parameter in the differential diagnosis of Crohn’s disease and intestinal tuberculosis. Intest Res 2014; 12: 42-7