克罗恩病患者的磁共振成像：使用口服超顺磁性造影剂时T2加权与T1加权钆增强磁共振序列的价值

MR imaging in patients with Crohn disease: value of T2- versus T1-weighted gadolinium-enhanced MR sequences with use of an oral superparamagnetic contrast agent.

作者信息

Maccioni Francesca, Bruni Antonio, Viscido Angelo, Colaiacomo Maria Chiara, Cocco Andrea, Montesani Chiara, Caprilli Renzo, Marini Mario

机构信息

Department of Radiological Sciences, Clinical Sciences, Gastroenterology Unit, and Surgical Sciences, University of Rome La Sapienza, Via Regina Elena 324, 00161 Rome, Italy.

出版信息

Radiology. 2006 Feb;238(2):517-30. doi: 10.1148/radiol.2381040244. Epub 2005 Dec 21.

DOI:10.1148/radiol.2381040244

PMID:16371574

Abstract

PURPOSE

To prospectively compare oral contrast-enhanced T2-weighted half-Fourier rapid acquisition with relaxation enhancement (RARE) magnetic resonance (MR) imaging with T1-weighted gadolinium-enhanced fast low-angle shot (FLASH) MR and standard examinations in the evaluation of Crohn disease.

MATERIALS AND METHODS

Institutional review board approval and informed consent were obtained. Fifty-nine patients with Crohn disease underwent MR imaging after oral administration of a superparamagnetic contrast agent; RARE plain and fat-suppressed sequences and FLASH sequences were performed before and after intravenous injection of gadolinium chelate. References were endoscopic, small-bowel barium, computed tomographic, ultrasonographic, and clinical-biochemical scoring of disease activity. Two radiologists analyzed MR images for presence and extent of Crohn disease lesions, presence of strictures or other complications, and degree of local inflammation. MR findings were correlated with endoscopic, radiologic, and clinical data (kappa statistic and Spearman rank correlation test).

RESULTS

T2-weighted MR was 95% accurate, 98% sensitive, and 78% specific for detection of ileal lesions. Agreement between T1- and T2-weighted images ranged from 0.77 for ileal lesions to 1.00 for colic lesions. T2-weighted MR enabled detection of 26 of 29 severe strictures, 17 of 24 enteroenteric fistulas, and all adhesions and abscesses; T1-weighted MR enabled detection of 20 of 29 severe strictures, 16 of 24 enteroenteric fistulas, and all adhesions and abscesses. Complications leading to surgery were found in 12 (20%) patients; these were assessed correctly with either T1- or T2-weighted images. T2-weighted signal intensities of the wall and mesentery correlated with biologic activity (P < .001, r of 0.774 and 0.712, respectively). Interobserver agreement was 0.642-1.00 for T2-weighted and 0.711-1.00 for T1-weighted images.

CONCLUSION

T2-weighted MR can depict Crohn disease lesions and help assess mural and transmural inflammation with the same accuracy as gadolinium-enhanced T1-weighted MR. Combination of gadolinium-enhanced T1- and T2-weighted sequences is useful in the assessment of Crohn disease.

摘要

目的

前瞻性比较口服对比剂增强的T2加权半傅里叶采集单次激发快速自旋回波（RARE）磁共振（MR）成像与T1加权钆增强快速低角度激发（FLASH）MR成像以及标准检查在克罗恩病评估中的效果。

材料与方法

获得机构审查委员会批准并取得患者知情同意。59例克罗恩病患者口服超顺磁性对比剂后接受MR成像检查；在静脉注射钆螯合物前后分别进行RARE平扫及脂肪抑制序列和FLASH序列扫描。参考依据为内镜检查、小肠钡剂造影、计算机断层扫描、超声检查以及疾病活动度的临床生化评分。两名放射科医生分析MR图像，以确定克罗恩病病变的存在及范围、是否存在狭窄或其他并发症以及局部炎症程度。将MR检查结果与内镜、放射学和临床数据进行相关性分析（kappa统计量和Spearman秩相关检验）。

结果

T2加权MR对回肠病变检测的准确率为95%，敏感度为98%，特异度为78%。T1加权和T2加权图像之间的一致性，回肠病变为0.77，结肠病变为1.00。T2加权MR能够检测出29个严重狭窄中的26个、24个肠-肠瘘中的17个以及所有粘连和脓肿；T1加权MR能够检测出29个严重狭窄中的20个、24个肠-肠瘘中的16个以及所有粘连和脓肿。12例（20%）患者发现了导致手术的并发症；T1加权或T2加权图像均能正确评估这些并发症。肠壁和肠系膜的T2加权信号强度与生物学活性相关（P <.001，r分别为0.774和0.712）。T2加权图像的观察者间一致性为0.642 - 1.00，T1加权图像为0.711 - 1.00。