Maconi Giovanni, Sampietro Gianluca M, Parente Fabrizio, Pompili Giovanni, Russo Antonio, Cristaldi Massimo, Arborio Giancarlo, Ardizzone Sandro, Matacena Giovanni, Taschieri Angelo Maria, Bianchi Porro Gabriele
Department of Gastroenterology, L. Sacco University Hospital, Milan, Italy.
Am J Gastroenterol. 2003 Jul;98(7):1545-55. doi: 10.1111/j.1572-0241.2003.07521.x.
Accurate assessment of intestinal complications of Crohn's disease (CD) is extremely important, both in clinical practice and in trials. The accuracy of radiographic and ultrasonographic diagnosis of internal fistulae and abscesses complicating CD is still debated and requires further investigation. We compared ultrasonography (US) and contrast radiography in detecting intestinal fistulae and abscesses complicating CD.
A prospective study was carried out on 625 consecutive CD patients who underwent complete evaluation of the intestinal tract by means of colonoscopy and double contrast barium enema, small bowel enteroclysis, and abdominal ultrasound (US). Computed tomography (CT) was also carried out in cases of severe CD with clinical suspicion of septic complications. The accuracy of US, barium radiology, and CT in detecting internal fistulae and abscesses was assessed by comparing results with intraoperative findings in 128 consecutive patients who underwent operation immediately after diagnostic workup.
Internal fistulae and intra-abdominal abscesses were identified intraoperatively in 56 (43.7%) and 26 (20.3%) patients, respectively. Diagnostic accuracy of US and x-ray studies in detecting internal fistulae was comparable (85.2% vs 84.8%), with sensitivity of 71.4% for US and 69.6% for x-ray studies, and specificity of 95.8% for both. Combination of radiographic techniques and US significantly improved diagnostic accuracy in detection of internal fistulae. In severe cases of CD with clinical suspicion of septic complications such as abdominal mass or fever, the accuracy of US, barium studies, and CT was 88.5%, 80.3%, and 77%, respectively (p = ns). The presence of abscesses was correctly detected in 90.9% of cases by means of US and in 86.4% by CT (p = ns), although accuracy was higher for CT (91.8%) than for US (86.9%) because of false positive results in US studies.
Despite the fact that barium radiology is widely considered the method of choice in detection of internal fistulae, accuracy is not entirely satisfactory. Comparable accuracy was found for US and CT. The combination of barium and US studies, or the sole use of US in more CD patients with more severe disease, can reliably detect most internal fistulae and abscesses.
在临床实践和试验中，准确评估克罗恩病（CD）的肠道并发症都极为重要。对于CD并发的内瘘和脓肿，放射学和超声检查诊断的准确性仍存在争议，需要进一步研究。我们比较了超声检查（US）和造影检查在检测CD并发的肠道瘘管和脓肿方面的效果。
对625例连续性CD患者进行了一项前瞻性研究，这些患者通过结肠镜检查、双重对比钡剂灌肠、小肠灌肠造影和腹部超声（US）对肠道进行了全面评估。对于临床怀疑有败血症并发症的重症CD患者，还进行了计算机断层扫描（CT）。通过将128例在诊断检查后立即接受手术的患者的术中结果与US、钡剂放射学和CT检查结果进行比较，评估了它们在检测内瘘和脓肿方面的准确性。
术中分别在56例（43.7%）和26例（20.3%）患者中发现了内瘘和腹腔内脓肿。US和X线检查在检测内瘘方面的诊断准确性相当（85.2%对84.8%），US的敏感性为71.4%，X线检查为69.6%，两者的特异性均为95.8%。放射学技术与US联合使用显著提高了检测内瘘的诊断准确性。在临床怀疑有败血症并发症（如腹部肿块或发热）的重症CD患者中，US、钡剂检查和CT的准确性分别为88.5%、80.3%和77%（p=无显著性差异）。通过US正确检测出脓肿的病例占90.9%，CT为86.4%（p=无显著性差异），尽管由于US检查存在假阳性结果，CT的准确性（91.8%）高于US（86.9%）。
尽管钡剂放射学被广泛认为是检测内瘘的首选方法，但其准确性并不完全令人满意。US和CT的准确性相当。钡剂和US检查联合使用，或在更多重症CD患者中单独使用US，能够可靠地检测出大多数内瘘和脓肿。
