Assessment of appropriateness of indications for CT enterography in younger patients

Abstract

Background: The small potential risk of radiation-induced cancer is increased in younger patients undergoing serial imaging with computed tomography enterography (CTE). We sought to determine the appropriateness of CTEs based on clinical indication in patients ≤35 years old, and the potential impact of evolution of practice to alternative magnetic resonance enterography (MRE). Methods: Over a 7-year period, the medical records of all patients ≤35 years old undergoing CTE were reviewed to determine the clinical indications for each CTE exam. An interdisciplinary consensus panel evaluated the appropriateness of all CTE exams based on American College of Radiology appropriateness criteria and peer-reviewed literature, classifying indications into " 'appropriate" or "inappropriate." For repeat CTEs, an "alternative MRE suggested" pathway was created. Criteria for evolution of practice to "alternative MRE" were suspicion of obstruction and evaluation of disease activity/therapeutic response in the absence of new symptoms. Results: In all, 2022 patients ≤35 years old underwent 2295 CTEs. Ninety-nine percent (2008/2022) of first-time CTE exams were "appropriate" by the defined criteria. A total of 197 patients (9.7%) underwent multiple exams, with 73% of these patients having Crohn's disease. Repeat exams occurred in 9% (18/197) with obstructive symptoms and evaluation of disease activity/therapeutic response in the absence of new symptoms in 41% (80/197). Conclusions: A multidisciplinary expert panel concluded that the vast majority of young patients underwent clinically appropriate first-time CTE exams. However, a shift in clinical practice to MRE appears warranted for approximately half of young patients undergoing repeat CTE examinations. Copyright © 2009 Crohn's & Colitis Foundation of America, Inc.