Sailer Johannes, Peloschek Philipp, Reinisch Walter, Vogelsang Harald, Turetschek Karl, Schima Wolfgang
Department of Radiology, Medical University of Vienna, Vienna, Austria.
Eur Radiol. 2008 Nov;18(11):2512-21. doi: 10.1007/s00330-008-1034-6. Epub 2008 May 27.
The purpose of this study was to assess the accuracy of MR enteroclysis in patients with Crohn's disease recurrence after ileocolic resection and to establish an MR scoring sytem. MR enteroclysis and endoscopy were performed in 30 patients with suspected Crohn's disease recurrence after ileocolic resection. Findings were evaluated by three radiologists, using an MR score based on image quality, contrast enhancement, and mural and extramural bowel-wall changes: MR0 (no abnormal features), MR1 (minimal mucosal changes), MR2 (diffuse aphtoid ileitis, moderate recurrence), and MR3 (severe recurrence with trans- and extramural changes). The endoscopic Rutgeerts score defines changes at the ileum on a scale from I0 to I4. In 3/30 (10%) patients, evaluation was not possible. The mean overall image quality was rated as 1.7 (kappa 0.78). Comparing MR and Rutgeerts score, the mean observer agreement for the total score rating was 77.8% (kappa 0.67). When comparing only scores below or above MR2-the threshold indicative of the necessity of medical treatment-there was a total agreement of 95.1% (kappa 0.84). MR enteroclysis allows assessment of Crohn's disease recurrence after ileocolic resection. The MR score is reproducible and shows high agreement with the approved endoscopic Rutgeerts score.
本研究的目的是评估磁共振小肠造影对回结肠切除术后克罗恩病复发患者的诊断准确性，并建立一种磁共振评分系统。对30例疑似回结肠切除术后克罗恩病复发的患者进行了磁共振小肠造影和内镜检查。由三名放射科医生根据图像质量、对比增强、肠壁和肠壁外变化对检查结果进行评估，采用的磁共振评分如下：MR0（无异常特征）、MR1（最小黏膜变化）、MR2（弥漫性阿弗他样回肠炎，中度复发）和MR3（伴有肠壁内和肠壁外变化的重度复发）。内镜Rutgeerts评分用于定义回肠的变化，范围从I0到I4。在30例患者中有3例（10%）无法进行评估。总体图像质量平均评分为1.7（kappa值为0.78）。比较磁共振评分和Rutgeerts评分，观察者对总分评定的平均一致性为77.8%（kappa值为0.67）。仅比较低于或高于MR2（表明需要药物治疗的阈值）的评分时，一致性为95.1%（kappa值为0.84）。磁共振小肠造影可用于评估回结肠切除术后克罗恩病的复发情况。磁共振评分具有可重复性，并且与认可的内镜Rutgeerts评分高度一致。
