Serra Carla, Menozzi Guido, Labate Antonio Maria Morselli, Giangregorio Francesco, Gionchetti Paolo, Beltrami Marina, Robotti Daniela, Fornari Fabio, Cammarota Teresa
Department of Internal Medicine and Gastroenterology, S. Orsola-Malpighi Hospital, University of Bologna, Italy.
Eur J Radiol. 2007 Apr;62(1):114-21. doi: 10.1016/j.ejrad.2006.11.027. Epub 2007 Jan 18.
To prospectively evaluate the vascularization of the thickened terminal ileum in Crohn's disease patients using contrast enhanced ultrasound (CEUS) and to compare the clinical activity measured by the Crohn's disease activity index (CDAI) with the CEUS findings.
Forty-eight of 104 consecutive patients (17 females and 31 males, aged 42.4+/-13.8 years) with a thickened terminal ileum at sonography were recruited for the study. CEUS examinations were performed using a real-time low mechanical index harmonic ultrasound technique after intravenous injection of a second generation contrast agent. We used two parameters to assess the vascularization of the bowel wall: a semi-quantitative method, the pattern of enhancement (which is the description of the arrangement of the enhanced layer in the bowel wall) and a quantitative method, the E/W ratio (which is the ratio between the major thickness of the enhanced layer, E, and the thickness of the entire wall section, W). In order to assess the accuracy of the CEUS findings in discriminating between active and inactive patients according to CDAI values (>150 and < or =150, respectively), the patterns of enhancement (four patterns) were dichotomized in two groups and an E/W ratio cutoff value was calculated to differentiate between poor and abundant bowel wall enhancement.
The CEUS findings, namely the pattern of enhancement and the E/W ratio (best cutoff value ranging between 0.43 and 0.47), had a sensitivity of 81.0% and 81.0%, respectively, a specificity of 63.0% and 55.6%, respectively, a positive predictive value of 63.0% and 58.6%, respectively, and a negative predictive value of 81.0% and 78.9%, respectively, in distinguishing patients with active and inactive disease.
CEUS assessment of diseased bowel wall vascularization may be a sensitive tool for the detection of inflammatory activity.
采用超声造影（CEUS）前瞻性评估克罗恩病患者增厚的回肠末端的血管形成情况，并将克罗恩病活动指数（CDAI）所测定的临床活动度与CEUS检查结果进行比较。
本研究纳入了超声检查发现回肠末端增厚的104例连续患者中的48例（17例女性，31例男性，年龄42.4±13.8岁）。静脉注射第二代造影剂后，采用实时低机械指数谐波超声技术进行CEUS检查。我们使用两个参数评估肠壁的血管形成情况：一种半定量方法，即增强模式（描述增强层在肠壁中的排列）；另一种定量方法，即E/W比值（增强层的主要厚度E与整个肠壁厚度W的比值）。为了评估根据CDAI值（分别>150和≤150）区分活动期和非活动期患者时CEUS检查结果的准确性，将增强模式（四种模式）分为两组，并计算E/W比值的临界值以区分肠壁增强不佳和增强丰富的情况。
在区分活动期和非活动期疾病患者时，CEUS检查结果，即增强模式和E/W比值（最佳临界值在0.43至0.47之间）的敏感性分别为81.0%和81.0%，特异性分别为63.0%和55.6%，阳性预测值分别为63.0%和58.6%，阴性预测值分别为81.0%和78.9%。
CEUS评估病变肠壁的血管形成情况可能是检测炎症活动的一种敏感工具。
