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To determine retrospectively if quantitative measures of the comb sign at CT enterography correlated with laboratory indications in Crohn's disease. We retrospectively included 72 known CD patients (47 male and 25 female patients) and 41 normal controls who had undergone CT enterography (CTE) from 2008 to 2010 and had high-sensitive C reaction protein (Hs-CRP) and erythrocyte sedimentation rate (ESR) results. We divided the 72 CD patients into two groups based on disease activity which was determined by Rutgeerts' score. 41 patients were characterized as active disease while 31 patients were as inactive disease. For each individual, one reformatted coronal CTE image in which the comb sign (vasa recta) was most obviously displayed was selected by two experienced radiologists in a double blind manner. For each image, 20 regions of interest (ROI) with area of 1 cm were drawn and placed over the site where the comb sign exists; the comb sign amount was counted in each ROI and recorded. Total amount of the comb sign were assessed from 20 ROI data. Quantitative comb sign results were compared with Hs-CRP and ESR level. Quantitative comb sign score is significantly higher in the CD group than in the control group at both the arterial stage and venous stage ( P < 0.001). Quantitative comb sign score is obviously higher in active CD patients than in inactive CD patients both at arterial stage and venous stage (3.63 vs. 2.86 at arterial stage; 3.53 vs. 2.90 at venous stage). ESR level was well correlated with quantitative comb sign score both at arterial and venous stage whereas Hs-CRP has no significant correlation at either stage. Quantitative comb sign results did well in predicting CD activity with the accuracy rate of 78.4% at arterial stage and 80% at venous stage when using 3.33 as the cutoff of quantitative comb sign score. Quantitative comb sign score is a promising CTE parameter in predicting CD activity and be well correlates with the ESR level. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The purpose of this study was to determine whether CT enterography (CTE) changes of Crohn''s disease (CD) after treatment correlated with clinical remission. Materials and methods: We retrospectively studied 50 known CD patients (male: 35; female: 15) with clinical remission in a period of 3 years (2005–2008). CD was diagnosed by clinical, enteroscopic and pathologic manifestations. Clinical remission was identified by experienced gastroenterologists using the combing criteria of clinical, endoscopy and laboratory tests. First CTE and endoscopy exams were performed during their first hospitalization in our hospital meanwhile CD diagnosis was made during that time. Repeated CTE and endoscopy exams were done after treatment. CTE findings were determined by two experienced radiologists with double-blind approach. Each patient was analyzed for the CTE parameters including bowel wall attenuation, bowel wall thickening (>3mm), bowel wall thickening types (type A: multilayered mural stratification; type B: two layers with strong mucosal enhancement and prominent low-density submucosa; type C: two layers without strong mucosal enhancement; type D: homogeneous enhancement) comb sign, luminal stenosis (mild: luminal diameter 2–3cm; moderate: luminal diameter 1–2cm; severe: luminal diameter<1cm) and the presence of extraenteric complications (such as fistulas and abscess). All the quantitative parameters were measured three times by each review. Results: After treatment, bowel wall thickening was attenuated in 88% of CD patients. Thickness of bowel wall was decreased from 8.8±2.8mm to 6.4±1.9mm (P <0.001). CT value of bowel wall in portal stage was also declined from 90.0±15.4 (HU) to73.4±14.2 (HU (P <0.001). The percentage of patients with type A or B bowel wall thickening was decreased from 78.7% to 35.4%, while those with type C or D thickening was increased from 21.2% to 64.6% (P <0.001). The percentage of patients with comb sign was decreased from 88% to 60% (P =0.001). The percentage of patients with moderate or severe luminal stenosis was reduced from 74% to 32% (P <0.001). The ROC (receiver operating characteristic) analysis showed bowel wall attenuation (A z =0.89) and bowel wall thickness (A z =0.81) were the two best parameters to predict disease activity, and combining of these two values was better than using them solely (κ =0.71, P <0.001). The bowel wall attenuation (OR=9.56, P <0.001) and bowel wall thickness (OR=3.32, P =0.001) were significantly correlated with the disease activity in the following logistic regression analysis. Conclusion: Therapeutic effect of CD and disease activity can be properly evaluated by CTE. [Copyright &y& Elsevier]