Florie Jasper, Wasser Martin N J M, Arts-Cieslik Kasia, Akkerman Erik M, Siersema Peter D, Stoker Jaap
Department of Radiology, Academic Medical Center, G1-211, PO Box 22700, Amsterdam 1100 DE, The Netherlands.
AJR Am J Roentgenol. 2006 May;186(5):1384-92. doi: 10.2214/AJR.04.1454.
The purpose of this study was to evaluate the role of contrast-enhanced dynamic MRI in predicting the disease activity of Crohn's disease.
Forty-eight patients in two hospitals who had clinically suspected exacerbation of Crohn's disease were included in this study. In three levels of thickened small-bowel wall, axial dynamic T1-weighted sequences were performed every 4-6 sec for a total duration of 2-3 min after contrast administration; static T1-weighted turbo spin-echo sequences were acquired both before and after contrast administration. The slope of enhancement, enhancement ratio, time to enhancement, enhancement time, and thickness of the small-bowel wall were determined. These MRI results were compared with overall clinical grade, Crohn's disease activity index (CDAI), and Van Hees activity index. Clinical grade was based on clinical information, physical findings, laboratory studies, endoscopy, surgery, and other imaging studies. Spearman's correlation coefficient and p values were determined per hospital. Fisher's z-transformation was applied before pooling the correlation coefficients from both hospitals.
The enhancement ratio based on the static series showed significant correlation with the clinical grade (r = 0.29, p = 0.045), CDAI (r =0.31, p = 0.033), and Van Hees activity index (r = 0.36, p = 0.016). The enhancement ratio based on the dynamic series correlated significantly with the CDAI (r = 0.38, p = 0.016). Wall thickness correlated significantly with clinical grade (r = 0.47, p = 0.003) and Van Hees activity index (r = 0.41, p = 0.007).
These data suggest that the enhancement ratio of bowel wall after IV administration of gadodiamide and bowel wall thickness are weak to moderate indicators of the severity of Crohn's disease.
本研究旨在评估对比增强动态磁共振成像（MRI）在预测克罗恩病疾病活动度中的作用。
本研究纳入了两家医院中48例临床怀疑克罗恩病病情加重的患者。在增厚的小肠壁的三个层面，静脉注射造影剂后，每隔4 - 6秒进行一次轴向动态T1加权序列扫描，共持续2 - 3分钟；在注射造影剂前后均采集静态T1加权快速自旋回波序列。测定增强斜率、增强率、强化时间、增强持续时间和小肠壁厚度。将这些MRI结果与总体临床分级、克罗恩病活动指数（CDAI）和范赫斯活动指数进行比较。临床分级基于临床信息、体格检查、实验室检查、内镜检查、手术及其他影像学检查。每家医院分别确定斯皮尔曼相关系数和p值。在汇总两家医院的相关系数之前，应用费舍尔z变换。
基于静态序列的增强率与临床分级（r = 0.29，p = 0.045）、CDAI（r = 0.31，p = 0.033）和范赫斯活动指数（r = 0.36，p = 0.016）显著相关。基于动态序列的增强率与CDAI显著相关（r = 0.38，p = 0.016）。肠壁厚度与临床分级（r = 0.47，p = 0.003）和范赫斯活动指数（r = 0.41，p = 0.007）显著相关。
这些数据表明，静脉注射钆双胺后肠壁的增强率和肠壁厚度是克罗恩病严重程度的弱至中度指标。
