Durno C A, Sherman P, Williams T, Shuckett B, Dupuis A, Griffiths A M
Division of Gastroenterology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr Gastroenterol Nutr. 2000 Feb;30(2):170-4. doi: 10.1097/00005176-200002000-00014.
The distinction between ulcerative colitis and Crohn's disease is important, because treatment options and clinical course may vary. Magnetic resonance imaging (MRI) allows noninvasive transmural assessment of the intestine and may facilitate differentiation of ulcerative colitis from Crohn's disease. The objective of this prospective study was to determine whether MRI differentiates Crohn's disease from ulcerative colitis in children as effectively as colonoscopy with mucosal biopsies.
Fifteen patients underwent colonoscopy with biopsies followed by abdominal MRI. The MRI diagnosis, determined by two radiologists independently completing a standardized form was compared with the gastroenterologic diagnosis.
After colonoscopy and review of histology, Crohn's disease was diagnosed in nine patients, ulcerative colitis in five, and indeterminate colitis in one, who was excluded from study. Agreement of the MRI diagnosis with the gastroenterologic diagnosis was 4 of 4 (100%) for ulcerative colitis, 4 of 10 (40%) for Crohn's disease considering both radiologists, and 5 of 10 (50%) for Crohn's disease for each radiologist individually. Percentage of enhancement by MRI did not correlate with the severity of inflammation determined at endoscopy among the patients with Crohn's disease (r = -0.3, P = 0.366). There was agreement on severity of inflammation in three of four patients with ulcerative colitis.
Current MRI interpretation of inflammatory bowel disease did not adequately recognize Crohn's disease in children. Therefore, colonoscopy with biopsy remains the most accurate tool for determining the type and severity of inflammatory bowel disease in children and adolescents.
溃疡性结肠炎和克罗恩病的区分很重要，因为治疗方案和临床病程可能有所不同。磁共振成像（MRI）可对肠道进行无创性透壁评估，并可能有助于区分溃疡性结肠炎和克罗恩病。这项前瞻性研究的目的是确定MRI在区分儿童克罗恩病和溃疡性结肠炎方面是否与结肠镜检查及黏膜活检一样有效。
15名患者先接受了结肠镜检查及活检，随后进行腹部MRI检查。将两名放射科医生独立填写标准化表格得出的MRI诊断结果与胃肠病学诊断结果进行比较。
结肠镜检查及组织学检查后，9名患者被诊断为克罗恩病，5名患者被诊断为溃疡性结肠炎，1名患者被诊断为不确定性结肠炎，该患者被排除在研究之外。对于溃疡性结肠炎，MRI诊断与胃肠病学诊断的一致性为4/4（100%）；对于克罗恩病，两名放射科医生的诊断一致性为4/10（40%），每名放射科医生单独的诊断一致性为5/10（50%）。在克罗恩病患者中，MRI增强百分比与内镜检查确定的炎症严重程度不相关（r = -0.3，P = 0.366）。4名溃疡性结肠炎患者中有3名在炎症严重程度上达成了一致。
目前对炎症性肠病的MRI解读不能充分识别儿童克罗恩病。因此，结肠镜检查及活检仍然是确定儿童和青少年炎症性肠病类型和严重程度的最准确工具。
