Tillack Cornelia, Seiderer Julia, Brand Stephan, Göke Burkhard, Reiser Maximilian F, Schaefer Claus, Diepolder Helmut, Ochsenkühn Thomas, Herrmann Karin A
Department of Internal Medicine II, University of Munich-Grosshadern, Germany.
Inflamm Bowel Dis. 2008 Sep;14(9):1219-28. doi: 10.1002/ibd.20466.
The aim was to evaluate and compare the diagnostic performance of magnetic resonance enteroclysis (MRE) and wireless video capsule endoscopy (CE) in detecting and classifying small bowel Crohn's disease (CD) proximal to the terminal ileum.
Nineteen patients with histologically proven CD (M:F = 13:6; mean 34 years, range 17-65) were prospectively included in the study when presenting with clinical signs suggesting stricturing or inflammatory lesions of CD in the proximal small bowel. All patients underwent MRE with an infusion technique and were then admitted to CE.
As for the presence or absence of pathology, results of MRE and CE were in total agreement for 44/52 (85%) evaluated segments. In judging lesion severity, MRE and CE yielded identical results in 29/52 (56%) segments. MRE underestimated pathology in 7/52 (14%) segments and revealed more severe pathology in 6/52 (12%) segments. CE identified subtle (n = 7) or severe (n = 2) mucosal pathology while MRE was normal. CE entirely missed severe inflammatory mural changes depicted in MRE in 1/52 (2%) segments.
MRE and CE show good correlation in the detection and localization of inflammatory bowel disease. As for disease activity, MRE is inferior in the detection of superficial mucosal disease but reliably discloses the presence of severe inflammatory changes within the bowel wall and beyond, which may be underestimated from the endoscopic aspect of the mucosal surface. MRE helps to rule out severe stenoses that should be referred for immediate surgical intervention. In conclusion, both modalities are complementary and MRE should be used in more severe cases of Crohn's disease and in patients who might have involvement beyond the mucosa of the small bowel.
目的是评估和比较磁共振小肠造影（MRE）和无线视频胶囊内镜（CE）在检测和分类回肠末端近端小肠克罗恩病（CD）方面的诊断性能。
19例经组织学证实为CD的患者（男∶女 = 13∶6；平均34岁，范围17 - 65岁），当出现提示近端小肠CD狭窄或炎性病变的临床体征时，被前瞻性纳入研究。所有患者均采用注入技术进行MRE检查，然后接受CE检查。
对于是否存在病变，MRE和CE在52个评估节段中的44个（85%）结果完全一致。在判断病变严重程度时，MRE和CE在52个节段中的29个（56%）结果相同。MRE在52个节段中的7个（14%）低估了病变，在52个节段中的6个（12%）显示出更严重的病变。CE发现了细微（n = 7）或严重（n = 2）的黏膜病变，而此时MRE结果正常。CE在52个节段中的1个（2%）完全漏诊了MRE所显示的严重炎性肠壁改变。
MRE和CE在炎症性肠病的检测和定位方面具有良好的相关性。对于疾病活动度，MRE在检测浅表黏膜疾病方面较差，但能可靠地揭示肠壁内及肠壁外严重炎性改变的存在，而从黏膜表面的内镜角度来看，这些改变可能被低估。MRE有助于排除应立即进行手术干预的严重狭窄。总之，两种检查方式具有互补性，MRE应用于更严重的克罗恩病病例以及可能累及小肠黏膜以外的患者。
