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325 Abnormal Regional Homogeneity in Patients With Crohn's Disease and Its Relationship With Abdominal Pain
CTE to evaluate CD will undergo a standard exam and a low dose CTE exam in a random sequence on the same day. The standard exam was used to obtain FBP and adaptive statistical IR (ASIR) images and the low dose scans - the Model based IR (MBIR) images. Demographics, historic data and a stool sample for fecal calprotectin were collected from each patient. The Harvey Bradshaw Index (HBI) was used to determine clinical disease activity. De-identified, randomly ordered images were reviewed by 2 experienced radiologists, independently for signs of small bowel CD and an overall assessment of "active" or "inactive" was made. All available clinical data including fecal calprotectin was reviewed by an experienced Gastroenterologist to determine the presence or absence of disease activity which served as the gold standard for comparison with the CT findings. RESULTS: As of Nov. 2014, a total of 124 patients had been enrolled and underwent CTE scanning. 46% of the subjects were male with a mean age of 43.6 (SD15.7 yrs). The mean HBI was 4.5, 48.4% were clinically assessed to have active disease by the gastroenterologist. The Generalized estimating equations (GEE) method was used to compare the validity of the reconstruction algorithms (Table 1). These values all suggest non-inferiority, 95% confidence intervals cross the pre-specified non-inferiority margin of 0.1. Completion of enrolment are expected to produce narrower confidence intervals demonstrating no significant difference between the 3 techniques. Standard dose radiation exposure was 6.7 ± 3.8 mSv and low dose exposure was 2.9 ± 2.4 mSv (p<0.001). More frequently, image noise was rated moderate or higher (28.4 - 84.7%) for MBIR compared to only 2.6 - 4.5% for ASIR and FBP. CONCLUSION: Iterative reconstruction techniques for CTE have similar validity to traditional CTE techniques, at much lower radiation doses, for the identification of active small bowel inflammation in patients with Crohn's disease. Table 1
Abnormal Regional Homogeneity in Patients With Crohn's Disease and Its Relationship With Abdominal Pain Chunhui Bao, Peng Liu, Huirong Liu, Luyi Wu, Yin Shi, Jianye Zhang, Xiaoming Jin, Huangan Wu Background & aims: Increasing evidence indicates abnormal pain processing in the central nervous system in patients with Crohn's disease (CD). The purpose of this study was to understand changes in resting-state brain activity in CD patients in remission and its relationship with abdominal pain. Methods: Twenty-five CD patients with abdominal pain, 24 CD patients without abdominal pain, and 33 healthy control subjects were scanned using a 3.0 T functional magnetic resonance imaging (fMRI) scanner. Regional Homogeneity (ReHo) was used to assess resting-state brain activity among the three groups. Daily pain scores were collected 1 week before fMRI scanning. Results: Patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), supplementary motor area, and higher ReHo value in the temporal pole, whereas patients without abdominal pain exhibited lower ReHo value in the hippocampal/parahippocampal cortex and higher ReHo value in the dorsomedial prefrontal cortex (dmPFC) (all P<0.05). The ReHo values of the insula and MCC were significantly negatively correlated with abdominal pain scores (r=0.53, P=0.008, and r=-0.61, P=0.002, respectively) (Figure 1). Conclusion: We suggest that there exist different changes in resting-state brain activity between CD patients in remission with and without abdominal pain. The negative correlations between pain severity and ReHo values of the insula and MCC in the painful CD patients suggest the involvement of these brain regions in visceral pain processing.
Comparison of the validity of the 3 different reconstruction algorithms
327 A Randomized Comparison of High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Dysplastic Lesions During IBD Surveillance Colonoscopy Marietta Iacucci, Miriam Fort Gasia, Stefan J. Urbanski, Minoo Parham, Gilaad Kaplan, Remo Panaccione, Subrata Ghosh Background: Dye spraying chromoendoscopy (DSC) is considered the standard of practice for IBD surveillance colonoscopy. However, the resolution of high definition (HD) colonoscopy has increased considerably compared with standard definition colonoscopes and electronic filter techniques now allow detailed inspection of mucosal and vascular patterns. With changing technologies it is important to determine the optimum technique for detection of dysplastic lesions in IBD. Aim: To compare the following three different techniques for performing surveillance colonoscopy to detect colonic dysplastic lesions in IBD patients: HD, DSC (0.2% indigocarmine) and electronic virtual chromoendoscopy i-SCAN (EVC). Patients & Methods: A randomized study (NCT02098798) was conducted to determine the detection rates of neoplasia with HD alone, DSC or EVC in patients with long standing colitis, UC and CD. Consecutive patients with inactive disease were enrolled in 1:1:1 ratio into three arms of the study. Colonoscopy was performed using a Pentax EPKi processor and high-resolution video colonoscope (Pentax Tokyo). Endoscopic colonic lesions were classified by the Kudo pit pattern and Paris classification. Histopathologic assessment of the inflammatory activity was graded as no, mild to moderate, or severe inflammation. Neoplastic changes were classified by the new Vienna classification.The lesions of dysplasia-associated lesion or masses and adenoma-like masses (DALMs/ALMs), sessile serrated adenomas (SSAs), adenoma-like polyps (ALPs), hyperplastic polyps (HPs), and inflammatory polyps (IPs) were identified. The three arms were compared by Chi squared test. Results: 95 patients (46 female, median age 52 years, range 22-77 years) were assessed by HD (n=32, 33.7%), VEC (n=33, 34.7%) or DSC (n=30, 31.6%). Fifteen SSAs were found in 7 patients (15.6%); twenty-seven ALPs were found in 16 patients (28.1%); five DALMs were found in 4 patients (5.2%); thirty-eight HPs were found in 28 patients (39.6%) and eleven IPs were found in 10 patients (11.5%).The distribution of lesions for serrated adenoma (chi sq 7.07; p<0.05) and for tubular adenoma (chi sq 13.06; p<0.01) or comparing overall between dysplastic and non-dysplastic detection rate (chi sq 10.84; p<0.01) favoured HD or VEC but not DSC. HD had a sensitivity of 86.67%, specificity of 89.29%, PPV 89.66% and NPV 86.21% in detecting dysplastic lesions. DSC had a sensitivity of 66.67%, specificity of 88.57%, PPV 50%, NPV 93.94% and EVC had a sensitivity of 100%, specificity of 83.3%, PPV 64.71% and NPV 100%. Conclusion: Our results indicate that DSC, the currently accepted IBD surveillance standard of practice, is not more sensitive than either HD or VEC in detecting dysplastic lesions. In fact, the majority of dysplastic lesions were detected in the HD group. Number of colonic lesions and patients in each surveillance group
Figure.1. The significant differences in ReHo among the pain CD, non-pain CD, and HC groups with age, gender and weight as covariates. ( A) The main effectanalysis revealed significant differences inReHo values of the insula, HIPP/paraHIPP,dmPFC, MCC, SMA and temporal pole among the 3 groups. ( B) The post-hoc analysis showed that theReHo values of the insula, MCC and SMA in the pain CD group were lower and temporal pole was higher than the ReHo values of the othertwo groups. The ReHo values of the HIPP/paraHIPP in the non-pain group werelower and that of the dmPFC was higher than the ReHo values of the othertwo groups. (C) The ReHo values of the insula and MCC in the pain CD group were negatively correlated with the abdominal pain scores.HCs, healthy controls;HIPP/ paraHIPP, hippocampal/parahippocampal cortex;SMA, supplementary motor area; TP, temporal pole; VAS, visual analogue scale;* P<0.05, **P<0.01.
326 Effects of CT Reconstruction Algorithm on the Quantitative Assessment of Crohn's Disease: A Comparison of Standard and Low Dose CT Enterography Greg Rosenfeld, Jacqueline Brown, Patrick M. Vos, Jonathon Leipsic, Robert A. Enns, Brian Bressler BACKGROUND Traditional Computed tomography (CT) imaging relies on filtered back projection (FBP) for image reconstruction. Newer iterative reconstruction (IR) techniques use computer modeling to generate CT images with lower radiation exposure while retaining sufficient quality for accurate interpretation. CT Enterography (CTE) is the preferred imaging modality for assessing small bowel Crohn's Disease (CD). We report here preliminary findings comparing the validity of 2 low dose CTE techniques for evaluating inflammatory changes in patients suspected of having CD. METHODS: A total of 163 patients referred for diagnostic
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Abnormal Regional Homogeneity in Patients With Crohn's Disease and Its Relationship With Abdominal Pain Chunhui Bao, Peng Liu, Huirong Liu, Luyi Wu, Yin Shi, Jianye Zhang, Xiaoming Jin, Huangan Wu Background & aims: Increasing evidence indicates abnormal pain processing in the central nervous system in patients with Crohn's disease (CD). The purpose of this study was to understand changes in resting-state brain activity in CD patients in remission and its relationship with abdominal pain. Methods: Twenty-five CD patients with abdominal pain, 24 CD patients without abdominal pain, and 33 healthy control subjects were scanned using a 3.0 T functional magnetic resonance imaging (fMRI) scanner. Regional Homogeneity (ReHo) was used to assess resting-state brain activity among the three groups. Daily pain scores were collected 1 week before fMRI scanning. Results: Patients with abdominal pain exhibited lower ReHo values in the insula, middle cingulate cortex (MCC), supplementary motor area, and higher ReHo value in the temporal pole, whereas patients without abdominal pain exhibited lower ReHo value in the hippocampal/parahippocampal cortex and higher ReHo value in the dorsomedial prefrontal cortex (dmPFC) (all P<0.05). The ReHo values of the insula and MCC were significantly negatively correlated with abdominal pain scores (r=0.53, P=0.008, and r=-0.61, P=0.002, respectively) (Figure 1). Conclusion: We suggest that there exist different changes in resting-state brain activity between CD patients in remission with and without abdominal pain. The negative correlations between pain severity and ReHo values of the insula and MCC in the painful CD patients suggest the involvement of these brain regions in visceral pain processing.
Comparison of the validity of the 3 different reconstruction algorithms
327 A Randomized Comparison of High Definition Colonoscopy Alone With High Definition Dye Spraying and Electronic Virtual Chromoendoscopy Using iSCAN for Detection of Colonic Dysplastic Lesions During IBD Surveillance Colonoscopy Marietta Iacucci, Miriam Fort Gasia, Stefan J. Urbanski, Minoo Parham, Gilaad Kaplan, Remo Panaccione, Subrata Ghosh Background: Dye spraying chromoendoscopy (DSC) is considered the standard of practice for IBD surveillance colonoscopy. However, the resolution of high definition (HD) colonoscopy has increased considerably compared with standard definition colonoscopes and electronic filter techniques now allow detailed inspection of mucosal and vascular patterns. With changing technologies it is important to determine the optimum technique for detection of dysplastic lesions in IBD. Aim: To compare the following three different techniques for performing surveillance colonoscopy to detect colonic dysplastic lesions in IBD patients: HD, DSC (0.2% indigocarmine) and electronic virtual chromoendoscopy i-SCAN (EVC). Patients & Methods: A randomized study (NCT02098798) was conducted to determine the detection rates of neoplasia with HD alone, DSC or EVC in patients with long standing colitis, UC and CD. Consecutive patients with inactive disease were enrolled in 1:1:1 ratio into three arms of the study. Colonoscopy was performed using a Pentax EPKi processor and high-resolution video colonoscope (Pentax Tokyo). Endoscopic colonic lesions were classified by the Kudo pit pattern and Paris classification. Histopathologic assessment of the inflammatory activity was graded as no, mild to moderate, or severe inflammation. Neoplastic changes were classified by the new Vienna classification.The lesions of dysplasia-associated lesion or masses and adenoma-like masses (DALMs/ALMs), sessile serrated adenomas (SSAs), adenoma-like polyps (ALPs), hyperplastic polyps (HPs), and inflammatory polyps (IPs) were identified. The three arms were compared by Chi squared test. Results: 95 patients (46 female, median age 52 years, range 22-77 years) were assessed by HD (n=32, 33.7%), VEC (n=33, 34.7%) or DSC (n=30, 31.6%). Fifteen SSAs were found in 7 patients (15.6%); twenty-seven ALPs were found in 16 patients (28.1%); five DALMs were found in 4 patients (5.2%); thirty-eight HPs were found in 28 patients (39.6%) and eleven IPs were found in 10 patients (11.5%).The distribution of lesions for serrated adenoma (chi sq 7.07; p<0.05) and for tubular adenoma (chi sq 13.06; p<0.01) or comparing overall between dysplastic and non-dysplastic detection rate (chi sq 10.84; p<0.01) favoured HD or VEC but not DSC. HD had a sensitivity of 86.67%, specificity of 89.29%, PPV 89.66% and NPV 86.21% in detecting dysplastic lesions. DSC had a sensitivity of 66.67%, specificity of 88.57%, PPV 50%, NPV 93.94% and EVC had a sensitivity of 100%, specificity of 83.3%, PPV 64.71% and NPV 100%. Conclusion: Our results indicate that DSC, the currently accepted IBD surveillance standard of practice, is not more sensitive than either HD or VEC in detecting dysplastic lesions. In fact, the majority of dysplastic lesions were detected in the HD group. Number of colonic lesions and patients in each surveillance group
Figure.1. The significant differences in ReHo among the pain CD, non-pain CD, and HC groups with age, gender and weight as covariates. ( A) The main effectanalysis revealed significant differences inReHo values of the insula, HIPP/paraHIPP,dmPFC, MCC, SMA and temporal pole among the 3 groups. ( B) The post-hoc analysis showed that theReHo values of the insula, MCC and SMA in the pain CD group were lower and temporal pole was higher than the ReHo values of the othertwo groups. The ReHo values of the HIPP/paraHIPP in the non-pain group werelower and that of the dmPFC was higher than the ReHo values of the othertwo groups. (C) The ReHo values of the insula and MCC in the pain CD group were negatively correlated with the abdominal pain scores.HCs, healthy controls;HIPP/ paraHIPP, hippocampal/parahippocampal cortex;SMA, supplementary motor area; TP, temporal pole; VAS, visual analogue scale;* P<0.05, **P<0.01.
326 Effects of CT Reconstruction Algorithm on the Quantitative Assessment of Crohn's Disease: A Comparison of Standard and Low Dose CT Enterography Greg Rosenfeld, Jacqueline Brown, Patrick M. Vos, Jonathon Leipsic, Robert A. Enns, Brian Bressler BACKGROUND Traditional Computed tomography (CT) imaging relies on filtered back projection (FBP) for image reconstruction. Newer iterative reconstruction (IR) techniques use computer modeling to generate CT images with lower radiation exposure while retaining sufficient quality for accurate interpretation. CT Enterography (CTE) is the preferred imaging modality for assessing small bowel Crohn's Disease (CD). We report here preliminary findings comparing the validity of 2 low dose CTE techniques for evaluating inflammatory changes in patients suspected of having CD. METHODS: A total of 163 patients referred for diagnostic
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