Masselli Gabriele, Casciani Emanuele, Polettini Elisabetta, Gualdi Gianfranco
Radiology DEA Department, Academic Hospital Umberto I. La Sapienza University Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Eur Radiol. 2008 Mar;18(3):438-47. doi: 10.1007/s00330-007-0763-2. Epub 2007 Sep 25.
To prospectively compare the diagnostic accuracy of MR enteroclysis with duodenal intubation with MRI after drinking oral contrast agent only (MR enterography) with conventional enteroclysis (conv-E) as reference standard in patients with Crohn's disease. Forty consecutive patients (22 males and 18 females; mean age 36; range 16-74 years) with proven Crohn's disease underwent conv-E and MR imaging. Twenty-two patients underwent MR enteroclysis with intubation (MRE) and 18 underwent MR-enterography (MR per OS). Two radiologists reached a consensus about the following imaging findings: luminal distension and visualization of superficial mucosal, mural and mesenteric abnormalities. Standard descriptive statistics and a Wilcoxon rank sum test were used. Statistical significance was inferred at P < 0.05. There was no significant difference in the adequacy of luminal distention between the MRE and conv-E (P = 0.08), and both were statistically superior in comparison to MR per OS in the distension of the jejunum (P < 0.01) and less significant at the ileum and terminal ileum levels (P < 0.05). MRE and conv-E were comparable for the accuracy of superficial mucosal abnormalities; meanwhile conv-E compared with MR per OS was statistically superior (P < 0.01). MRE compared with MR per OS was statistically better when visualizing superficial abnormalities (P < 0.01). No statistically significant differences were found in assessing the diagnostic efficacy between MR examinations for the depiction of mural stenosis (P = 0.105) and fistulae (P = 0.67). The number of detected mesenteric findings was significantly higher with both MRE and MR per OS compared to conv-E (P < 0.01). MRE can serve as the diagnostic procedure for initially evaluating patients suspected of having Crohn's disease. MR per OS may have a role in patients that refuse or have failed intubation and also for follow-up.
以传统小肠造影（conv-E）为参考标准，前瞻性比较磁共振小肠造影联合十二指肠插管与仅饮用口服对比剂后的磁共振成像（磁共振小肠造影）在克罗恩病患者中的诊断准确性。40例经证实的克罗恩病患者（22例男性，18例女性；平均年龄36岁；范围16 - 74岁）接受了conv-E和磁共振成像检查。22例患者接受了插管磁共振小肠造影（MRE），18例接受了磁共振小肠造影（口服对比剂磁共振成像）。两名放射科医生就以下影像学表现达成共识：肠腔扩张以及浅表黏膜、肠壁和肠系膜异常的可视化。采用标准描述性统计和Wilcoxon秩和检验。P < 0.05时推断具有统计学意义。MRE和conv-E在肠腔扩张的充分性方面无显著差异（P = 0.08），两者在空肠扩张方面与口服对比剂磁共振成像相比均具有统计学优势（P < 0.01），在回肠和回肠末端水平差异较小（P < 0.05）。MRE和conv-E在浅表黏膜异常的准确性方面具有可比性；同时，conv-E与口服对比剂磁共振成像相比具有统计学优势（P < 0.01）。MRE在可视化浅表异常方面与口服对比剂磁共振成像相比具有统计学优势（P < 0.01）。在评估磁共振检查对肠壁狭窄（P = 0.105）和瘘管（P = 0.67）的诊断效能时未发现统计学显著差异。与conv-E相比，MRE和口服对比剂磁共振成像检测到的肠系膜表现数量均显著更高（P < 0.01）。MRE可作为初步评估疑似克罗恩病患者的诊断方法。口服对比剂磁共振成像在拒绝或插管失败的患者以及随访中可能有作用。
