Masselli Gabriele, Brizi Maria Gabriella, Menchini Laura, Minordi Laura, Vecchioli Scaldazza Amorino
Divisione di Radiologia, Ospedale S. Eugenio, Rome.
Radiol Med. 2005 Sep;110(3):221-33.
The aim of our prospective study was to evaluate the diagnostic accuracy of MR Enteroclysis (MRE) to assess the extension and complications of Crohn's Disease (CD) in comparison with conventional enteroclysis (CE).
The study comprised 30 consecutive patients affected by Crohn's disease (18 women and 12 men; age range 16-76, mean age 40.6 years), who underwent conventional and MR enteroclysis. The MR enteroclysis protocol includes three sequences: coronal and axial FIESTA and ssFSE sequences and T1-3D-FSPGR sequences before and after intravenous injection of gadolinium, acquired after administration of 1.6-2 l of iso-osmolar polyethylene glycol solution via a nasojejunal catheter. Two radiologists blindly scored each sequence for opacification of the lumen, small bowel distension and image quality and evaluated the following parameters: presence of wall ulcers, pseudopolyps, stenoses and fistulae.
The accuracy of the FIESTA sequence was significantly higher (p<0.01) than the ssFSE and 3D FSPGR sequences in the evaluation of lumen opacification and bowel distension, and for the overall quality of the images (p<0.01). The sensitivity and specificity of MRE were 82% and 100% for the visualisation of parietal ulcers, 87% and 100% for pseudopolyps, 100% and 88% for stenoses, 75% and 100% for parietal fistulae. High-grade stenoses with prestenotic dilation (n=6) and low-grade stenoses (n=9) were visualised both by MRE and CE. MRE also showed abscesses in two patients, not seen at CE. The FIESTA and ssFSE sequences had higher accuracy in the detection of wall ulcers and fistulae, whereas the 3D FSPGR sequences showed higher accuracy in the evaluation of wall thickening.
MRE is able to demonstrate the spectrum of superficial, intramural and exoenteric alterations in Crohn's disease and closely correlates with CE in demonstrating alterations of the bowel lumen and wall.
我们这项前瞻性研究的目的是评估磁共振小肠造影（MRE）在评估克罗恩病（CD）的病变范围及并发症方面的诊断准确性，并与传统小肠造影（CE）进行比较。
该研究纳入了30例连续的克罗恩病患者（18例女性，12例男性；年龄范围16 - 76岁，平均年龄40.6岁），这些患者均接受了传统小肠造影和磁共振小肠造影检查。磁共振小肠造影方案包括三个序列：冠状位和轴位的快速成像稳态进动序列（FIESTA）和单次激发快速自旋回波序列（ssFSE），以及静脉注射钆对比剂前后的三维扰相梯度回波序列（T1 - 3D - FSPGR），这些序列是在经鼻空肠导管注入1.6 - 2升等渗聚乙二醇溶液后采集的。两名放射科医生对每个序列的肠腔显影、小肠扩张情况及图像质量进行盲法评分，并评估以下参数：壁溃疡、假息肉、狭窄和瘘管的存在情况。
在评估肠腔显影、小肠扩张及图像整体质量方面，快速成像稳态进动序列（FIESTA）的准确性显著高于单次激发快速自旋回波序列（ssFSE）和三维扰相梯度回波序列（3D FSPGR）（p < 0.01）。磁共振小肠造影（MRE）对壁溃疡的可视化敏感性和特异性分别为82%和100%，对假息肉分别为87%和100%，对狭窄分别为100%和88%，对壁瘘分别为75%和100%。磁共振小肠造影（MRE）和传统小肠造影（CE）均显示了伴有狭窄前扩张的重度狭窄（n = 6）和轻度狭窄（n = 9）。磁共振小肠造影（MRE）还显示了两名患者存在脓肿，而传统小肠造影（CE）未发现。快速成像稳态进动序列（FIESTA）和单次激发快速自旋回波序列（ssFSE）在检测壁溃疡和瘘管方面准确性更高，而三维扰相梯度回波序列（3D FSPGR）在评估肠壁增厚方面准确性更高。
磁共振小肠造影（MRE）能够显示克罗恩病的浅表、壁内和肠外改变谱，并且在显示肠腔和肠壁改变方面与传统小肠造影（CE）密切相关。
