• Korean Journal of Radiology
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• 제23권1호
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• pp.1-5
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• 2022

• 대한소화기학회지
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• 제72권6호
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• pp.277-280
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• 2018

Although small bowel the mainly occupies the most part of the gastrointestinal tract, small intestine tumors are rare, insidious in clinical presentation, and frequently represent a diagnostic and management challenge. Small bowel tumors are generally classified as epithelial, mesenchymal, lymphoproliferative, or metastatic. Familial adenomatous polyposis and Peutz-Jeghers syndrome are the most common inherited intestinal polyposis syndromes. Until the advent of capsule endoscopy (CE) and device-assisted enteroscopy (DAE) coupled with the advances in radiology, physicians had limited diagnostic examination for small bowel examination. CE and new radiologic imaging techniques have made it easier to detect small bowel tumors. DAE allows more diagnosis and deeper reach in small intestine. CT enteroclysis/CT enterography (CTE) provides information about adjacent organs as well as pictures of the intestinal lumen side. Compared to CTE, Magnetic resonance enteroclysis/enterography provides the advantage of soft tissue contrast and multiplane imaging without radiation exposure. Treatment and prognosis are tailored to each histological subtype of tumors.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1077-1088
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• 2018

Objective: To correlate CT parameters on detector-based dual-energy CT enterography (DECTE) with Crohn's disease activity index (CDAI) and externally validate quantitative CT parameters. Materials and Methods: Thirty-nine patients with CD were retrospectively enrolled. Two radiologists reviewed DECTE images by consensus for qualitative and quantitative CT features. CT attenuation and iodine concentration for the diseased bowel were also measured. Univariate statistical tests were used to evaluate whether there was a significant difference in CTE features between remission and active groups, on the basis of the CDAI score. Pearson's correlation test and multiple linear regression analyses were used to assess the correlation between quantitative CT parameters and CDAI. For external validation, an additional 33 consecutive patients were recruited. The correlation and concordance rate were calculated between real and estimated CDAI. Results: There were significant differences between remission and active groups in the bowel enhancement pattern, subjective degree of enhancement, mesenteric fat infiltration, comb sign, and obstruction (p < 0.05). Significant correlations were found between CDAI and quantitative CT parameters, including number of lesions (correlation coefficient, r = 0.573), bowel wall thickness (r = 0.477), iodine concentration (r = 0.744), and relative degree of enhancement (r = 0.541; p < 0.05). Iodine concentration remained the sole independent variable associated with CDAI in multivariate analysis (p = 0.001). The linear regression equation for CDAI (y) and iodine concentration (x) was y = 53.549x + 55.111. For validation patients, a significant correlation (r = 0.925; p < 0.001) and high concordance rate (87.9%, 29/33) were observed between real and estimated CDAIs. Conclusion: Iodine concentration, measured on detector-based DECTE, represents a convenient and reproducible biomarker to monitor disease activity in CD.

• Korean Journal of Radiology
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• 제23권1호
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• pp.30-41
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• 2022

Objective: Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are considered substitutes for each other for evaluating Crohn's disease (CD). However, the adequacy of mixing them for routine periodic follow-up for CD has not been established. This study aimed to compare MRE alone with the mixed use of CTE and MRE for the periodic follow-up of small bowel inflammation in patients with CD. Materials and Methods: We retrospectively compared two non-randomized groups, each comprising 96 patients with CD. One group underwent CTE and MRE (MRE followed by CTE or vice versa) for the follow-up of CD (interval, 13-27 months [median, 22 months]), and the other group underwent MRE alone (interval, 15-26 months [median, 21 months]). However, these two groups were similar in clinical characteristics. Three independent readers from three different institutions determined whether inflammation had decreased, remained unchanged, or increased within the entire small bowel and the terminal ileum based on sequential enterography of the patients after appropriate blinding. We compared the two groups for inter-reader agreement and accuracy (terminal ileum only) using endoscopy as the reference standard for enterographic interpretation. Results: The inter-reader agreement was greater in the MRE alone group for the entire small bowel (intraclass correlation coefficient [ICC]: 0.683 vs. 0.473; p = 0.005) and the terminal ileum (ICC: 0.656 vs. 0.490; p = 0.030). The interpretation accuracy was higher in the MRE alone group without statistical significance (70.9%-74.5% vs. 57.9%-64.9% in individual readers; adjusted odds ratio = 3.21; p = 0.077). Conclusion: The mixed use of CTE and MRE was inferior to MRE alone in terms of inter-reader reliability and could probably be less accurate than MRE alone for routine monitoring of small bowel inflammation in patients with CD. Therefore, the consistent use of MRE is favored for this purpose.

• Korean Journal of Radiology
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• 제19권6호
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• pp.1089-1098
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• 2018

Objective: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn's disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. Materials and Methods: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. Results: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between single-phase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09-9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21-6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-${\alpha}$ therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07-0.95; p = 0.041). Conclusion: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.

• 대한영상의학회지
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• 제84권3호
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• pp.536-549
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• 2023

염증성 장질환의 두 가지 주요 질환으로 크론병과 궤양성 대장염이 있다. 염증성 장질환이 의심될 때, 최근에는 장벽과 장벽 밖을 모두 평가할 수 있고 다른 질환과의 감별에도 도움을 받을 수 있어 CT 소장조영술이 초기 영상검사로 널리 사용되고 있다. 염증성 장질환이 의심되는 경우, 크론병과 궤양성 대장염과의 구분이 필요하며 대부분의 경우 어렵지 않게 구분이 되나 그렇지 않은 경우가 있어 이를 염증성 장질환-미분류(inflammatory bowel diseaseunclassified)로 구분한다. 궤양성 대장염의 경우 CT 소견은 비특이적인 경우가 많아 영상검사만으로 다른 질환과 감별하기 어려운 경우가 많다. 크론병의 경우 특징적인 CT 소견이 진단에 도움이 되는 경우가 많으나 이를 모방하는 질환들이 있으며 특히 결핵성 장염은 여전히 크론병과 감별이 어려울 수 있다. 최근에는 크론병과 유사한 다발성 궤양과 협착이 있는 환자의 일부에서 SLCO2A1이라는 프로스타글란딘 수송체를 암호화하는 유전자의 돌연변이가 질환의 원인인 것으로 밝혀져 크론병과 감별하기 위해 유전자 검사가 시행되고 있다.

• 대한영상의학회지
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• 제84권3호
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• pp.520-535
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• 2023

위장관 출혈은 단일 질환이 아니라 광범위한 위장 질환의 증상 및 임상적 발현이다. 임상적 양상에 따라 명백한 출혈, 잠재 출혈, 원인 불명 출혈로 나눌 수 있으며, 출혈 위치에 따라 Treiz 인대를 기준으로 상부 또는 하부 위장관 출혈로 분류할 수 있다. 혈관 질환, 용종, 종양, 크론병, 이소성 췌장 및 이소성 위조직 등 다양한 질환이 위장관 출혈을 일으킬 수 있다. 명백한 출혈을 위한 영상 검사기법은 CT 혈관조영술, 고식적 혈관조영술 및 핵의학적 검사 등이 사용된다. 잠재 위장관 출혈을 평가하기 위한 영상검사로는 CT 소장조영술이 주로 사용되며, 위장관을 적절히 팽창해서 영상을 획득해야 위음성 혹은 위양성을 최소화하여 진단능을 높일 수 있다. CT 소장조영술에서 진단이 확실하지 않은 경우, Meckel scan이 보완적으로 사용될 수 있다. 원인 불명 위장관 출혈에 대한 검사는 임상 양상과 임상의 혹은 영상의학과 의사의 선호도에 따라 다양한 검사가 시행될 수 있으며, 이에 대한 추가적인 연구가 필요하다.

• 대한영상의학회지
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• 제84권4호
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• pp.911-922
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• 2023

목적 전산화단층촬영 소장조영술 준비를 위해서 사용된 중성 경구 조영제인 희석된 폴리에틸렌 글리콜 용액과 저밀도(0.1% w/v) 바륨 현탁액 사이의 소장 팽창과 부작용을 비교하였다. 대상과 방법 전산화단층촬영 소장조영술을 시행 받은 총 173명의 환자가 연구에 포함되었다. 50명의 환자는 바륨 현탁액을, 123명의 환자는 희석된 등삼투압의 폴리에틸렌 글리콜 용액을 사용하였다. 동일한 양인 1L를 투여하였다. 두 명의 독립된 검토자가 공장과 회장에서 5점 척도로 소장 팽창을 평가하였다. 두 그룹 간의 부작용 비교를 위해서 경구 조영제 투입 후 환자들이 구역, 구토, 설사 및 복통을 호소하는지 여부에 대하여 조사하였다. 결과 회장과 공장에서, 희석된 폴리에틸렌 글리콜 용액은 두 검토자 모두에서 바륨 현탁액과 차이가 없었다(회장: 검토자 1, 중앙값, 4; 4, 사분위수 범위, 3-4; 3-4, p = 0.997; 검토자 2, 중앙값, 4; 4, 사분위수 범위, 3.3-4.0; 3-4, p = 0.064, 공장: 검토자 1, 중앙값, 2; 2, 사분위수 범위, 2-3; 2-3, p = 0.560; 검토자 2, 중앙값, 3; 2, 사분위수 범위, 2-3; 2-3, p = 0.192). 모든 환자에서 두 가지 경구 조영제 투여 후 즉각적인 부작용을 호소하지 않았다. 결론 희석된 폴리에틸렌 글리콜 용액은 바륨 현탁액과 비교하여 소장 팽창에 차이가 없고, 검사 직후 부작용이 없으므로, 유용한 대체제가 될 수 있다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제24권1호
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• pp.19-29
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• 2021

Purpose: To assess parent perspectives of the current and potential future tests for their child with inflammatory bowel disease (IBD). Methods: New Zealand parents of a child with IBD were invited to complete an anonymous online survey. Experiences relating to their child's blood or faecal tests, medical imaging (abdominal ultrasound [US], abdominal computerised tomography [CT] and magnetic resonance enterography) and colonoscopy were collected. Perceived attitudes to potential future testing of urine, saliva, and breath, were sought. Results: Twenty-eight parents, 93% female completed the survey, and 86% were aged between 35 and 54 years. Baseline information was provided by parents for 27 of 28 children, 70.3% had Crohn's disease with a mean disease duration of 2.67 years. Blood tests were the most requested and completed tests, while CT was the least ordered and most refused test. Colonoscopy was rated as the least comfortable and generated the most worry. Explanation of test significantly improved parent's levels of understanding when their child had blood, faecal, imaging (US) or colonoscopy tests. Providing an explanation, test invasiveness and the impact of the blood results may have on their child's treatment significantly improved parents' comfort levels. However, explanation of colonoscopy generated a significant parental concerns. Saliva, urine and blood tests were chosen as the most preferred disease monitoring tests. Conclusion: Parents preferred any tests less invasive than colonoscopy for monitoring their child's IBD. Although providing explanation of their child's tests enhanced parents' understanding, it can also affect parents' levels of concern and comfort.