Parente F, Greco S, Molteni M, Cucino C, Maconi G, Sampietro G M, Danelli P G, Cristaldi M, Bianco R, Gallus S, Bianchi Porro G
Department of Gastroenterology, L. Sacco University Hospital, Milan, Italy.
Aliment Pharmacol Ther. 2003 Nov 15;18(10):1009-16. doi: 10.1046/j.1365-2036.2003.01796.x.
Although bowel ultrasound is a widely accepted diagnostic tool in bowel diseases, its value as the primary imaging procedure in patients with symptoms/signs suggestive of inflammatory bowel disorders is still unclear.
To investigate the accuracy of bowel ultrasound compared with barium X-ray studies, computed tomography, endoscopy and bowel surgery in the initial assessment of inflammatory bowel disorders.
Four hundred and eighty-seven patients hospitalized consecutively for symptoms or signs suggestive of a bowel disorder between December 1999 and March 2002 were initially enrolled in the study. All patients underwent bowel ultrasound as the first imaging procedure within 36 h of admission; radiographic evaluations, endoscopy and/or surgery were then performed as appropriate and the results of these investigations were used as the gold standard.
Three hundred and thirty-six patients had pathological findings of the bowel detectable at ultrasound as the final diagnosis. The main organic disorders found were Crohn's disease (56%), ulcerative/indeterminate colitis (30%), bowel tumours (5%), appendicitis/diverticulitis (2%) and other inflammatory conditions (8%). The overall sensitivity and specificity of bowel ultrasound were 85% and 95%, respectively, whereas the positive and negative predictive values were 98% and 75%, respectively. Comparisons of ultrasound with X-ray or endoscopic results by disease localization showed that the diagnostic performance of ultrasound was higher for inflammatory conditions of the ileum and sigmoid/descending colon (sensitivity of 92% and 87%, respectively), whereas abnormalities localized in the rectum, duodenum and proximal jejunum were often missed by ultrasound.
In expert hands, bowel ultrasound is highly predictive of inflammatory disease localized in the ileum or colon, and may well be used as the primary imaging method when Crohn's disease or ulcerative colitis is suspected on a clinical basis.
尽管肠道超声是肠道疾病中广泛认可的诊断工具，但其作为提示炎症性肠病症状/体征患者的主要成像检查方法的价值仍不明确。
探讨肠道超声与钡剂X线检查、计算机断层扫描、内镜检查及肠道手术相比，在炎症性肠病初始评估中的准确性。
1999年12月至2002年3月期间，487例因提示肠道疾病的症状或体征而连续住院的患者最初纳入本研究。所有患者在入院36小时内接受肠道超声作为首次成像检查；然后根据情况进行影像学评估、内镜检查和/或手术，并将这些检查结果用作金标准。
最终诊断为336例患者肠道超声检查发现有病理改变。发现的主要器质性疾病为克罗恩病（56%）、溃疡性/未定型结肠炎（30%）、肠道肿瘤（5%）、阑尾炎/憩室炎（2%）和其他炎症性疾病（8%）。肠道超声的总体敏感性和特异性分别为85%和95%，而阳性和阴性预测值分别为98%和75%。按疾病定位比较超声与X线或内镜检查结果显示，超声对回肠和乙状结肠/降结肠炎症性疾病的诊断性能较高（敏感性分别为92%和87%），而超声常漏诊直肠、十二指肠和空肠近端的异常。
在专家手中，肠道超声对回肠或结肠局限性炎症性疾病具有高度预测性，当临床怀疑克罗恩病或溃疡性结肠炎时，很可能用作主要成像方法。
