A94 USE OF LOW-DOSE CTE IN PREDICTING ACTIVE INFLAMMATION IN CROHN’S PATIENTS WITH INTERMEDIATE FECAL CALPROTECTIN LEVELS

Crohn’s disease (CD) is a condition that affects young individuals. Clinically assessed disease activity by a Gastroenterologist is the gold standard for identifying patients with active inflammation and relapse. Fecal Calprotectin (FC) is a biomarker that is an independent indicator of active inflammation. Bressler et al has shown that FC levels <100 µg/g strongly predict quiescent CD, and those >250 µg/g strongly predict active inflammation/relapse. FC levels between 100–250 µg/g is an indeterminate zone that warrants further testing to confirm the presence/absence of disease. Computed tomography enterography (CTE) is a proposed next test. Recent research has shown that low-dose CTE using model-based iterative reconstruction (MBIR) is non-inferior to standard dose CTE for identifying signs of small bowel inflammation. To assess the utility of MBIR CTE signs, in patients with intermediate FC levels, for predicting those who would have active inflammation on clinical assesment. A single-center, retrospective cohort study of 163 patients subjected to clinical assessment, FC measurement and low dose CTE to evaluate CD activity between November 2012 & February 2015. The CTE studies for each patient were reviewed by two radiologists for radiographic findings of small bowel CD inflammation. Clinically assessed disease activity by a Gastroenterologist served as the reference standard. Multivariate logistic regression was used to build a scoring equation based on FC levels & radiographic signs to predict active disease in the reference standard. Of the 163 patients, 92 (56%) patients had active inflammation based on clinical assessment. Sixty-five (71%) of the 92 patients clinically diagnosed with active inflammation also had CTE that was deemed active by overall radiologist impression. Fifty (70%) of the 71 patients clinically diagnosed with inactive inflammation also had CTE that was deemed inactive by overall radiologist impression. Sensitivity, specificity, PPV & NPV of overall radiologic impression for CD activity was 0.70, 0.71, 0.75, 0.65, respectively. 138 patients had measured FC levels. Seventy-eight (57%) had clinically active disease & 60 (43%) had clinically inactive disease. In those with active disease, 16 (20%), 13(17%) & 49(63%) had FC levels <100 µg/g, 100–250 µg/g, >250 µg/g, respectively. In those with inactive disease, 53 (88%), 7(12%) & 0(0%) had FC levels <100 µg/g, 100–250 µg/g, >250 µg/g, respectively. An equation based on mural stratification & FC level predicted active disease the best. This equation had a sensitivity, specificity, PPV, NPV & accuracy of 0.82, 0.90, 0.91, 0.79 & 0.85, respectively. In patients with FC levels between 101–250, MBIR CTE is a reasonable further test to confirm the presence/absence of disease None

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