Log in

Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix

  • Published:
Abdominal Imaging Aims and scope Submit manuscript

Abstract

The objective of our retrospective study was to determine the MDCT-enteroclysis appearance of the appendix in patients with Crohn’s disease and to correlate this appearance with the status of the disease. We reviewed the MDCT-enteroclysis examinations of 76 patients with Crohn’s disease. Images were analyzed for visualization of the appendix, largest axial diameter of the appendix and degrees of enhancement. Findings were correlated with the status of the disease (active vs. nonactive) and compared with those observed in a control group. Among the various variables, hyperenhancement of the appendiceal wall was found in 18.9% of patients with active disease and in no patients with inactive disease nor in the control group (P = 0.0023). This sign had a specificity of 100% for differentiating between active and inactive Crohn’s disease. We conclude that increased appendiceal wall enhancement is, at a statistically significant level, more frequently observed in patients with active Crohn’s disease by comparison with patients with inactive disease and control subjects. This result suggests that this finding may be used as an additional MDCT-enteroclysis finding to determine the activity of the disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Crohn BB, Ginzberg L, Oppenheimer GD (1932) Regional ileitis: a pathological and clinical entity. JAMA 99:1323–1328

    Google Scholar 

  2. Agha FP, Ghahremani GG, Panella JS, Kaufman MW (1987) Appendicitis as the initial manifestation of Crohn’s disease: radiologic features and prognosis. AJR Am J Roentgenol 149:515–518

    CAS  PubMed  Google Scholar 

  3. Fonkalsrud EW, Ament ME, Fleisher D (1982) Management of the appendix in young patients with Crohn’s disease. Arch Surg 117:11–14

    CAS  PubMed  Google Scholar 

  4. Balthazar EJ, Megibow AJ, Hulnick D, Gordon RB, Beranbaum ER (1986) CT of appendicitis. AJR Am J Roentgenol 147:705–710

    CAS  PubMed  Google Scholar 

  5. Baumgart DC, Sandborn WJ (2007) Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 369:1641–1657

    Article  CAS  PubMed  Google Scholar 

  6. Boudiaf M, Jaff A, Soyer P, et al. (2004) Small bowel diseases: prospective evaluation of multidetector row helical CT enteroclysis in 107 consecutives patients. Radiology 203:338–344

    Article  Google Scholar 

  7. Schindera ST, Nelson RC, DeLong DM, et al. (2007) Multi-detector row CT of the small bowel: peak enhancement temporal window—initial experience. Radiology 243:438–444

    Article  PubMed  Google Scholar 

  8. Soyer P, Boudiaf M, Fargeaudou Y, et al. (2008) Celiac disease in adults: evaluation with MDCT enteroclysis. AJR Am J Roentgenol 191:1483–1492

    Article  PubMed  Google Scholar 

  9. Rao PM, Mueller PR (1998) Clinical and pathologic variants of appendiceal disease: CT features. AJR Am J Roentgenol 170:1335–1340

    CAS  PubMed  Google Scholar 

  10. Rao PM, Rhea JT, Novelline RA (1997) Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21:686–692

    Article  CAS  PubMed  Google Scholar 

  11. Applegate KE, Tello R, Ying J (2003) Hypothesis testing III: counts and medians. Radiology 228:603–608

    Article  PubMed  Google Scholar 

  12. Sandborn WJ, Feagan BG, Hanauer SB, et al. (2002) A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn’s disease. Gastroenterology 122:512–530

    Article  PubMed  Google Scholar 

  13. Daperno M, D’Haens G, Van Assche G, et al. (2004) Development and validation of a new, simplified endoscopic activity score for Crohn’s disease: the SES-CD. Gastrointest Endosc 60:505–512

    Article  PubMed  Google Scholar 

  14. Cellier C, Sahmoud T, Froguel E, et al. (1994) Correlations between clinical activity, endoscopic severity, and biological parameters in colonic and ileocolonic Crohn’s disease: a prospective multicentre study of 121 cases. The Groupe d’Etudes Thérapeutiques des Affections Inflammatoires Digestives. Gut 35:231–235

    Article  CAS  PubMed  Google Scholar 

  15. Gal E, Geller A, Fraser G, Levi Z, Niv Y (2008) Assessment and validation of the new capsule endoscopy Crohn’s disease activity index (CECDAI). Dig Dis Sci 53:1933–1937

    Article  PubMed  Google Scholar 

  16. Benjaminov O, Atri M, Hamilton P, Rappaport D (2002) Frequency of visualization and thickness of normal appendix at nonenhanced helical CT. Radiology 225:400–406

    Article  PubMed  Google Scholar 

  17. Huwart L, El Khoury M, Lesavre A, et al. (2007) What is the thickness of the normal appendix on MDCT? J Radiol 88:385–389

    Article  CAS  PubMed  Google Scholar 

  18. Kim HC, Yang DM, Shin HP (2009) Why can we not see a normal appendix on CT? An evaluation of the factors influencing nonvisualization of a normal appendix by 64-slice MDCT. Clin Imaging 33:33–38

    Article  PubMed  Google Scholar 

  19. Maglinte DDT, Sandrasegaran K, Lappas JC, Chiorean M (2007) CT enteroclysis. Radiology 245:661–671

    Article  PubMed  Google Scholar 

  20. Kermarrec E, Barbary C, Corby S, et al. (2007) CT enteroclysis: a pictorial essay. J Radiol 88:235–250

    Article  CAS  PubMed  Google Scholar 

  21. Peyrin-Biroulet L, Chamaillard M, Gonzalez F, et al. (2007) Mesenteric fat in Crohn’s disease: a pathogenetic hallmark or an innocent bystander? Gut 56:577–583

    Article  CAS  PubMed  Google Scholar 

  22. Lockhart-Mummery HE, Morson BC (1960) Crohn’s disease (regional enteritis) of the large intestine and its distinction from ulcerative colitis. Gut 1:87–105

    Article  CAS  PubMed  Google Scholar 

  23. Yang SS, Gibson P, McCaughey RS, Arcari FA, Bernstein J (1979) Primary Crohn’s disease of the appendix. Ann Surg 189:334–339

    Article  CAS  PubMed  Google Scholar 

  24. Lindhagen T, Ekelund G, Leandoer L, et al. (1982) Crohn’s disease confined to the appendix. Dis Colon Rectum 25:805–808

    Article  CAS  PubMed  Google Scholar 

  25. Ariel I, Vinograd I, Hershlag A, et al. (1986) Crohn’s disease isolated to the appendix. Hum Pathol 158:355–360

    Google Scholar 

  26. Bronner MP (2004) Granulomatous appendicitis and the appendix in idiopathic inflammatory bowel disease. Semin Diagn Pathol 21:98–107

    Article  PubMed  Google Scholar 

  27. Hoeffel C, Crema MD, Belkacem A, et al. (2006) Multi-detector row CT: spectrum of diseases involving the ileocecal area. Radiographics 26:1373–1390

    Article  PubMed  Google Scholar 

  28. Ripollés T, Martinez MJ, Morote V, Errando J (2006) Appendiceal involvement in Crohn’s disease: gray-scale sonography and color Doppler flow features. AJR Am J Roentgenol 186:1071–1078

    Article  PubMed  Google Scholar 

  29. Liu YB, Liang CH, Zhang ZL, et al. (2006) Crohn disease of small bowel: multidetector row CT with CT enteroclysis, dynamic contrast enhancement, CT angiography, and 3D imaging. Abdom Imaging 31:668–674

    Article  PubMed  Google Scholar 

  30. Puylaert JBCM, van der Werf SDJ, Ulrich C, Veldhuizen RW (1988) Crohn disease of the ileocecal region: US visualization of the appendix. Radiology 166:741–743

    CAS  PubMed  Google Scholar 

  31. Kroft SH, Stryker SJ, Rao MS (1994) Appendiceal involvement as skip lesion in ulcerative colitis. Mod Pathol 7:912–914

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Philippe Soyer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Soyer, P., Boudiaf, M., Dray, X. et al. Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix. Abdom Imaging 35, 654–660 (2010). https://doi.org/10.1007/s00261-009-9575-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-009-9575-y

Keywords

Navigation