Diagnostic value of MR and CT enterography in post-operative recurrence of Crohn’s disease: a systematic review and meta-analysis

• Published in: Abdominal imaging Vol. 49; no. 11; pp. 3975 - 3986
• Main Authors: Chavoshi, Mohammadreza, Zamani, Sara, Kolahdoozan, Shadi, Radmard, Amir Reza
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2024; Springer Nature B.V
• Subjects: Anastomosis; Colon; Colonoscopy; Computed tomography; Crohn Disease - diagnostic imaging; Crohn Disease - surgery; Crohn's disease; Crohns disease; Edema; Gastroenterology; Health and safety screening; Hepatology; Heterogeneity; Humans; Imaging; Lesions; Magnetic Resonance Imaging - methods; Medicine; Medicine & Public Health; Meta-analysis; Population studies; Postoperative Complications - diagnostic imaging; Radiology; Recurrence; Review; Sensitivity; Sensitivity and Specificity; Stenosis; Thickening; Tomography, X-Ray Computed - methods; Recurrence; Post-operative; Enterography; Diagnostic accuracy; Crohn’s disease
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-024-04394-6

Post-operative recurrence is a critical issue in the surveillance of Crohn’s disease after ileocecal resection. This meta-analysis aims to assess the diagnostic yield of enterography techniques in post-operative recurrence of Crohn’s disease. A systematic electronic bibliographic databases search was conducted. The inclusion criteria of original articles were: Utilized MR enterography or CT enterography after ileocolonic resection; Documented recurrence by ileo-colonoscopy (Rutgeerts’ score ≥ i2); Provided crude data of diagnostic performance. A random-effect method was used for analysis. Relative risk and diagnostic value of each imaging feature were calculated. Eleven studies (11 populations and 589 patients) were included (4 CTE and 7 MRE with 248 and 341 patients, respectively). The pooled sensitivity and specificity of the enterography were 91% (95% CI: 0.85–0.95) and 75% (95% CI: 0.56–0.87), respectively. The pooled sensitivity and specificity of CTE were 93% (95% CI: 0.87–0.96) and 67% (95% CI: 0.35–0.90), respectively. MRE revealed pooled sensitivity and specificity of 90% (95% CI: 0.78–0.96) and 78% (95% CI: 0.57–0.90), respectively. The inter-study heterogeneity was low for sensitivity (I 2  = 29%, p-value = 0.17) and high for specificity (I 2  = 85%, p-value < 0.01). Wall enhancement, anastomosis wall thickening, anastomosis stenosis, pre-anastomotic dilatation, penetrating lesion, comb sign, and perivisceral edema were significantly higher in POR patients. Wall thickening and penetrating lesion were the most sensitive (81%) and specific (97%) findings, respectively. MRE and CTE exhibit high sensitivity and acceptable specificity (especially MRE) for detection of recurrence in Crohn’s disease which makes them an effective initial screening tool and reserves ileo-colonoscopy for those patients with inconclusive enterography results. Graphical Abstract