MRI Differentiating Gut TB and Crohn's

Study Overview
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Brief Summary
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It is clinically challenging to differentiate Crohn's disease from gut tuberculosis especially in regions endemic of tuberculosis infection. The investigators plan to perform magnetic resonance enterography (MRE) who presented to our hospital in Shenzhen, China for new onset of lower gastrointestinal symptoms and ileocecal mucosal lesions of uncertain diagnosis as evidenced by the presence of inflammation, ulceration, strictures or nodules on colonoscopy. MRE findings will be independently interpreted by two radiologistsThe role of MRE in distinguishing gut tuberculosis from Crohn's disease will be determined.

Detailed Description
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The clinical presentation of gut tuberculosis and Crohn's disease is very similar. In areas endemic of tuberculosis infection, differentiating the two diseases remains difficult. Both disease entities can have similar clinical, endoscopic and histological findings. Yet, wrongly diagnosing gut tuberculosis as Crohn's disease can potentially result in disastrous outcomes, especially when anti-tumor necrosis factor therapy, an important therapeutic option for Crohn's disease, can result in fulminant reactivation of tuberculosis. Magnetic resonance enterography (MRE) is emerging as a effective imaging modality in evaluating the disease status of Crohn's disease. MRE, unlike computed tomography, emits no radiation, and is suitable for repeated serial imaging in younger-age populations. Ulcerations, strictures, transmural enhancement and mesenteric combing of the small bowel can be clearly demonstrated via MRE in Crohn's disease. Yet, the utilization of MRE in diagnosing gut tuberculosis remains largely unexplored. Whether MRE can be used to differentiate gut tuberculosis from Crohn's disease remains unknown. The investigators plan to consecutively recruit 150 patients presenting to our hospital in Shenzhen, China, for new onset of lower gastrointestinal symptoms and ileocecal mucosal lesions of uncertain diagnosis as evidenced by the presence of inflammation, ulceration, strictures or nodules on colonoscopy.All recruited participants will undergo MRE, to be performed on a 1.5 Tesla scanner (Magnetom Avanto, Siemens Healthcare, Erlangen, Germany). MRE findings will be independently interpreted by two radiologists with special expertise in abdominal MR imaging and blinded to the patients' clinical data. The relationship between radiological patterns and clinical, endoscopic and histological findings will be analyzed. The role of MRE in distinguishing gut tuberculosis from Crohn's disease will be determined.

Official Title
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Differentiating Gut Tuberculosis and Crohn's Disease Via Magnetic Resonance Enterography

Conditions
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Crohn Disease, Intestinal Tuberculosis

Intervention / Treatment
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* Diagnostic Test: Magnetic resonance imaging


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: New-onset lower gastrointestinal symptoms of less than 3 months Ileocecal mucosal lesions of uncertain diagnosis as evidenced by the presence of inflammation, ulceration, strictures or nodules on colonoscopy. No prior tuberculosis treatment No prior immunomodulatory or anti-tumor necrosis factor treatment Exclusion Criteria: Stage 4 or 5 chronic kidney disease, i.e. a glomerular filtration rate of <=30 ml/min. Contraindications to magnetic resonance imaging, including the installation of metallic devices or implants in-situ (e.g. pacemakers) Prior intestinal resection Known concomitant chronic small / large bowel disease, including ulcerative colitis, eosinophilic gastroenteritis, NSAID-related enterography etc.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Magnetic resonance imaging<br>Patients with new-onset of lower gastrointestinal symptoms and ileocecal mucosal lesions of uncertain diagnosis as evidenced by the presence of inflammation, ulceration, strictures or nodules on colonoscopy. | Diagnostic Test: Magnetic resonance imaging<br>* Enterography performed via magnetic resonance imaging<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Small / large bowel transmural enhancement | Via magnetic resonance enterography independently interpreted by two radiologist with expertise | During procedure | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Skip lesions in small / large bowel | Via magnetic resonance enterography independently interpreted by two radiologist with expertise | During procedure | 
| Vascular engorgement | Via magnetic resonance enterography independently interpreted by two radiologist with expertise | During procedure | 
| Mesenteric combing | Via magnetic resonance enterography independently interpreted by two radiologist with expertise | During procedure | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TB, CD, MRE, ileocecal