Pascu M, Roznowski A B, Müller H-P, Adler A, Wiedenmann B, Dignass A U
Department of Medicine, Charité Medical School, Campus Virchow, Berlin, Germany.
Inflamm Bowel Dis. 2004 Jul;10(4):373-82. doi: 10.1097/00054725-200407000-00008.
Ileocolonoscopy represents the diagnostic standard in the work-up of patients with inflammatory bowel diseases (IBD). Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy.
To compare the usefulness oftransabdominal ultrasound (US) and magnetic resonance imaging (MRI) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel.
61 patients with IBD [37 Crohn's disease (CD) and 24 ulcerative colitis (UC)] were prospectively studied. All patients underwent clinical and laboratory assessment, ileocolonoscopy, transabdominal sonography, and MRI within 5 days. Involved bowel segments were defined as those with bowel wall thickness >3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI. To compare disease activity endoscopic, MRI and US findings were graded with newly developed scores.
The segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD. The accuracy was better in patients with UC than in patients with CD for both US and MRI. The endoscopic activity index (EAI) correlated stronger with the US activity index (r = 0.884) than with the MRI activity index (r = 0.344). The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD. All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD.
This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel.
回结肠镜检查是炎症性肠病（IBD）患者检查的诊断标准。由于结肠镜检查具有侵入性且会引起疼痛感，患者通常不愿接受结肠镜检查。
比较经腹超声（US）和磁共振成像（MRI）在评估局限于回肠末端和大肠的IBD患者疾病范围和活动度方面的效用。
对61例IBD患者[37例克罗恩病（CD）和24例溃疡性结肠炎（UC）]进行前瞻性研究。所有患者在5天内接受了临床和实验室评估、回结肠镜检查、经腹超声检查和MRI检查。受累肠段定义为肠壁厚度>3mm且超声显示多普勒信号增强或MRI显示肠壁有对比增强的肠段。为比较疾病活动度，内镜、MRI和US检查结果采用新制定的评分系统进行分级。
逐段分析显示，US识别活动性IBD的总体准确率为89%，MRI为73%。对于US和MRI，UC患者的准确率均高于CD患者。内镜活动指数（EAI）与US活动指数（r = 0.884）的相关性强于与MRI活动指数（r = 0.344）的相关性。与CD患者相比，UC患者中US和MRI活动指数与EAI的相关性更好。所有三种成像方法在UC患者中均与临床疾病活动度显著相关，但在CD患者中无此相关性。
本研究提供了有力证据，表明US应被视为回肠末端和大肠IBD患者随访的首选方法。
