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E1381. Inflammation to Fistula: The Imaging Biography of Crohn's Disease
Authors
  1. Tiffany Yu; University of California Los Angeles
  2. Rinat Masamed; University of California Los Angeles
  3. Shaden Mohammad; Olive View-UCLA Medical Center
  4. Anokh Pahwa; Olive View-UCLA Medical Center
  5. Maitraya Patel; University of California Los Angeles
  6. Evan Raff; Olive View-UCLA Medical Center
  7. Karoly Viragh; Olive View-UCLA Medical Center
Background
Crohn’s disease (CD) is an idiopathic chronic, progressive, relapsing/remitting inflammatory bowel disease (IBD) affecting approximately 1% of the U.S. population, which has characteristic radiologic manifestations and disease course, yet often confusing terminology. The goal of the exhibit is to depict the “biographical” spectrum of the disease, from earliest presentation to late complications, with radiological, pathological and clinical correlation, focusing on the Montreal/Paris classification and the Society of Abdominal Radiology (SAR)/American Gastroenterology Association (AGA) Consensus Reporting Nomenclature.

Educational Goals / Teaching Points
1. Clinical overview of CD, including a flowchart of the natural course and description of the Montreal classification. 2. Review of imaging techniques and the recommended SAR/AGA reporting nomenclature with example images of the major terms. 3. Interactive case review to illustrate the spectrum of CD.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit includes a clinical overview of CD, imaging tools and techniques, clinical and radiologic descriptors, with emphasis of teaching points using an interactive case review. The epidemiology, pathophysiology, clinical manifestations, and the diagnostic and therapeutic approaches are briefly reviewed, including the three main phenotypes of the Montreal/Paris system (nonstricturing/nonpenetrating, stricturing, and penetrating). Computed tomography (CT) and magnetic resonance (MR) enterography, fluoroscopy, and ultrasound techniques and performance characteristics are discussed. Clinical and radiologic descriptors are defined per the SAR/AGA Consensus Reporting Nomenclature. Radiological descriptors are reviewed with imaging examples of segmental mural hyperenhancement, wall thickening, stratification, fibrofatty proliferation, pseudosacculation, stricturing, sinus tract/fistula formation, inflammatory mass, and other “Aunt Minnie” findings, including skip lesions, the string sign, and the horn sign. Marshak’s 10 principles of CD are reviewed. For the interactive case review, multiple carefully selected educational cases with board-style review questions are presented to illustrate CD with appropriate Montreal classification and consensus terminology. The gastrointestinal (GI) manifestations are presented with emphasis on the relative frequency of occurrence, severity, and complications along the GI tract from “mouth to anus,” as well as perianal disease. The extra-GI manifestations are presented with emphasis on the diverse, multiorgan involvement: pancreaticobiliary (cholelithiasis, primary sclerosing cholangitis, pancreatitis), renal (stones), musculoskeletal (sacroiliitis, avascular necrosis of the femoral heads), vascular (mesenteric venous thrombosis), and dermatological (pyoderma gangrenosum, erythema nodosum).

Conclusion
Radiologists’ familiarity with the manifestations, classification and consensus reporting nomenclature will result in effective interdisciplinary communication of CD.