A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography

A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography Publisher Pubmed

Khosravi B¹ ; Salehnia A¹ ; Pak N¹ ; Montazeri SA² ; Sima AR³ ; Vahedi H³ ; Malekzadeh R³ ; Radmard AR^{1, 3}

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1. Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2. Department of Radiology, Mayo Clinic, Florida, United States
3. Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: Inflammatory Bowel Diseases Published:2023

Abstract

Background: Differentiating ulcerative colitis-associated backwashileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings. Methods: After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices. Results: Circumferential mural thickening (90% vs 1%, P <. 001) and inner-wall enhancement (P <. 001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P <. 001), and asymmetric hyperenhancement (P <. 001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P <. 001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%. Conclusions: Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI. © 2022 The Author(s). Published by Oxford University Press on behalf of Crohn's & Colitis Foundation. All rights reserved.

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Amir Reza Radmard (4)

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Style	Citing Format
MLA	Khosravi B, et al.. "A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography." Inflammatory Bowel Diseases, vol. 29, no. 1, 2023, pp. 42-50.
APA	Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR (2023). A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography. Inflammatory Bowel Diseases, 29(1), 42-50.
Chicago	Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, Malekzadeh R, Radmard AR. "A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography." Inflammatory Bowel Diseases 29, no. 1 (2023): 42-50.
Harvard	Khosravi B et al. (2023) 'A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography', Inflammatory Bowel Diseases, 29(1), pp. 42-50.
Vancouver	Khosravi B, Salehnia A, Pak N, Montazeri SA, Sima AR, Vahedi H, et al.. A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography. Inflammatory Bowel Diseases. 2023;29(1):42-50.
BibTex	@article{ author = {Khosravi B and Salehnia A and Pak N and Montazeri SA and Sima AR and Vahedi H and Malekzadeh R and Radmard AR}, title = {A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography}, journal = {Inflammatory Bowel Diseases}, volume = {29}, number = {1}, pages = {42-50}, year = {2023} }
RIS	TY - JOUR AU - Khosravi B AU - Salehnia A AU - Pak N AU - Montazeri SA AU - Sima AR AU - Vahedi H AU - Malekzadeh R AU - Radmard AR TI - A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in Mr Enterography JO - Inflammatory Bowel Diseases VL - 29 IS - 1 SP - 42 EP - 50 PY - 2023 ER -

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