ABDOMINAL RADIOLOGY 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 Giuseppe Lo Re • Maria Cappello • Chiara Tudisca • Massimo Galia • Claudia Randazzo • Antonio Craxı ` • Calogero Camma ` • Andrea Giovagnoni • Massimo Midiri Received: 2 February 2013 / Accepted: 30 July 2013 Ó Italian Society of Medical Radiology 2013 Abstract Purpose Few studies have correlated computed tomog- raphy enterography (CTE) findings with Crohn’s disease (CD) clinical and biochemical activity. The aim of this study was to evaluate correlations between CTE findings with CD activity. Materials and methods The CTE datasets from 62 patients were retrospectively reviewed for different parameters: bowel wall thickening and hyperenhancement, mesenteric alterations, abdominal free fluid and compli- cations related to the disease (fistulas, strictures, absces- ses). Activity was assessed using the Crohn’s Disease Activity Index (CDAI) and some biochemical markers (C- reactive protein, erythrocyte sedimentation rate, alpha 2-globulins, fibrinogen, platelets, haemoglobin). Correla- tions between CTE parameters, clinical activity score and laboratory parameters were assessed by logistic regression. Results CDAI was significantly correlated with increased fat density (p = 0.03) and intestinal strictures (p = 0.04). Platelet counts were elevated in patients with enlarged mesenteric lymph nodes (p = 0.009) and the comb sign (p = 0.05). Serum alpha 2-globulins were higher in the presence of the comb sign (p = 0.03). Conclusion The CTE finding of perienteric inflammation (increased fat density) and vascular engorgement of the vasa recta in CD patients suggest that the disease is clini- cally active and that these patients may require more aggressive treatment than patients without these findings. Keywords Crohn disease Á Radiography Á Small intestine Á Radiography Á Computed tomography Introduction Assessment of inflammatory activity in Crohn’s disease (CD) has become crucial to drive therapeutic choices and monitor their effect [1]. In the past, this evaluation was based on clinical indexes, mainly the Crohn’s Disease Activity Index (CDAI), integrated by laboratory parame- ters including C-reactive protein (CRP), erythrocyte sedi- mentation rate (ESR), and orosomucoids, and endoscopic findings [2, 3]. Indeed, endoscopy can assess only mucosal inflammation, which, in a transmural disease like CD, might not be enough [4]. Recently, a few papers have suggested the role of radiological techniques such as computed tomography enteroclysis or enterography (CTE) and magnetic reso- nance enteroclysis or enterography (MRE) not only in detecting extramural complications but also in the evalu- ation of disease activity [5–9]. The CTE finding of either enteric signs such as mural stratification and hyperenhancement or perienteric signs like mesenteric hypertrophy or engorged vasa recta, the so- called ‘‘comb sign’’, has been found to correlate either with G. Lo Re Á C. Tudisca (&) Á M. Galia Á M. Midiri Sezione di Scienze Radiologiche, Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi (DIBIMEF), Azienda Ospedaliera Policlinico Paolo Giaccone, Via del Vespro, 129, 90127 Palermo, Italy e-mail: chiaratudisca@gmail.com M. Cappello Á C. Randazzo Á A. Craxı ` Á C. Camma ` Sezione e U.O.C. di Gastroenterologia, Dipartimento Biomedico di Medicina Interna e Specialistica, Azienda Ospedaliera Policlinico Paolo Giaccone, Piazza Delle Cliniche 2, 90127 Palermo, Italy A. Giovagnoni Istituto di Radiologia, Ospedale Regionale Torrette, Via Conca, 60020 Ancona, Italy 123 Radiol med DOI 10.1007/s11547-013-0377-5