Evaluation of CT enterography findings for endoscopic complete remission after anti-TNF-α therapy in patients with Crohn's disease.

Background: Unnecessary prolonged treatment with biologic agents for Crohn's disease (CD) patients with endoscopic complete remission (CR) might increase the opportunistic infections. Purpose: To evaluate computed tomography enterography (CTE) findings obtained on CD patients achieving endoscopic CR after anti-tumor necrosis factor (TNF)-α therapy. Material and Methods: Thirty-six consecutive patients with CD who had received anti-TNF- α therapy and undergone pre-and post-therapy CTE and ileocolonoscopy were initially enrolled. CTE was performed with a standard-dose enteric-phase scan. Eleven patients were excluded due to a mismatch of follow-up intervals or a long interval (>2 weeks) between CTE and ileocolonoscopy; additionally, five patients were excluded due to surgical intervention during the follow-up period. Therefore, 20 patients finally were analyzed. Two blinded readers evaluated the pre-and post-therapy CTE images by consensus for active inflammation, i.e. mural hyperenhancement, mural thickening (thickness > 3 mm), mural stratification, and increased peri-enteric fat attenuation in the rectum, colon, and terminal ileum. Endoscopic CR indicated mucosal healing identified by ileocolonoscopy and served as the reference standard. Results: Nine patients with 16 bowel segments showed endoscopic CR. Ten of those segments showed residual abnormalities including mild mural hyperenhancement (9/16, P = 0.03), mild mural thickening (6/16, P < 0.001), and both findings (5/16, P < 0.001) on post-therapy CTE. The non-CR group (11 patients; 17 bowel segments) showed a higher concordance rate with post-therapy CTE (88%, 15/17) than did the CR group (38%, 6/16) (P = 0.004). Conclusion: Residual mild mural hyperenhancement and mild mural thickening were seen on post-therapy CTE in over half of the bowel segments showing endoscopic CR. [ABSTRACT FROM AUTHOR]