Lay Summary
Proposal No. IBD-0122R
Principal Investigator: John H. Kwon, M.D., (replacement PI); Philip M. Ginsburg, M.D. (original PI)
Applicant Organization: Johns Hopkins University (Baltimore, Maryland, U.S.A.)
Project Title: Differentiating fibrostenosing from inflammatory small bowel disease in patients with Crohn's disease using combined 18F-fluorodeoxyglucose positron emission tomography and computed tomography
Period of Award: September 1, 2004 - December 31, 2005
Crohn’s disease (CD) is characterized by different subtypes, including patients with fibrostenosing disease who develop bowel narrowings called strictures. Approximately half of all patients with stricturing Crohn’s disease undergo surgery for narrowings in the small intestine that result in obstruction. Some have fixed scar-like strictures that would not improve and may even be made worse with infliximab biologic therapy, while others have narrowings due to active inflammation that could lessen with infliximab therapy. Unfortunately, no single test is available that reliably differentiates between these two causes of bowel narrowing and obstructive symptoms. However, inflamed tissues are more metabolically active than scars. Preliminary experiences suggest that positron emission tomography (PET), a new molecular imaging technique that characterizes tissues with high metabolic activity, may be used to localize gastrointestinal inflammation. Recently, combination PET and computed tomography (CT) scanners have been developed that are likely to provide even more detailed pictures of narrowed intestine.
Our study examines the accuracy of PET/CT at differentiating narrowings due to inflammation from narrowings due to scars in patients with Crohn’s disease who require surgery for obstructing symptoms. If PET/CT scans are found to be accurate at differentiating between these two processes, then future patient management may be significantly affected. Surgery for medically treatable inflammatory disease could be potentially avoided and clinical decisions regarding the use of infliximab, a new biologic agent, may be influenced.