Fraquelli M, Sarno A, Girelli C, Laudi C, Buscarini E, Villa C, Robotti D, Porta P, Cammarota T, Ercole E, Rigazio C, Senore C, Pera A, Malacrida V, Gallo C, Maconi G
Second Division Gastroenterology, Fondazione IRCCS Ospedale Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
Dig Liver Dis. 2008 Nov;40(11):860-6. doi: 10.1016/j.dld.2008.04.006. Epub 2008 Jun 25.
Bowel ultrasonography is increasingly used in the detection and follow-up of patients with Crohn's disease, but a limitation to its further diffusion is the lack of standardisation of ultrasonography parameters.
This study aimed to standardise the most common bowel ultrasonography parameters in order to develop an unequivocal imaging interpretation and to assess bowel ultrasonography reproducibility.
Twenty patients with Crohn's disease were examined.
Six ultrasonographers (mean bowel ultrasonography experience=16 years) performed the study. They chose and discussed a common assessment methodology concerning eight ultrasonography parameters: bowel wall thickness, bowel wall pattern, bowel wall blood flow, enlarged mesenteric lymph nodes, mesenteric hypertrophy, abdominal free fluid, and stenosis or fistulae at four preliminary meetings. The day of the study operators were randomised to two rooms where they independently and in turn performed ultrasonography scans. Interobserver agreement was scored by kappa statistics.
Excellent k values were observed for bowel wall thickness (0.72-1). k Values were poor for bowel wall pattern (-0.22-0.85) and good for bowel wall blood flow (0.53-0.89). The presence of lymph nodes was reproducible (0.56-0.90) except in one case (0.25). Concordance on free fluid was excellent (0.85-1), whereas that on mesenteric hypertrophy was generally poor (0.14-0.69). Agreement was excellent for stenosis (0.81-1) whereas that for fistula was fair in room abscesses (0.31-0.48) and very good in room B (0.87-1).
Bowel ultrasonography signs used in Crohn's disease can be standardised as most of them showed a fair to good reproducibility. In particular, bowel wall thickness, the most relevant parameter for Crohn's disease detection, showed an excellent reproducibility.
肠道超声检查在克罗恩病患者的检测和随访中应用越来越广泛，但超声检查参数缺乏标准化限制了其进一步推广。
本研究旨在使最常见的肠道超声检查参数标准化，以形成明确的影像学解读，并评估肠道超声检查的可重复性。
对20例克罗恩病患者进行了检查。
6名超声检查人员（肠道超声检查平均经验 = 16年）参与了该研究。他们在4次预备会议上选择并讨论了关于8项超声检查参数的通用评估方法：肠壁厚度、肠壁形态、肠壁血流、肠系膜淋巴结肿大、肠系膜肥厚、腹腔游离液体以及狭窄或瘘管。研究当天，操作人员被随机分配到两个房间，他们依次独立进行超声扫描。采用kappa统计量对观察者间的一致性进行评分。
肠壁厚度的kappa值极佳（0.72 - 1）。肠壁形态的kappa值较差（-0.22 - 0.85），肠壁血流的kappa值良好（0.53 - 0.89）。除1例（kappa值为0.25）外，淋巴结的存在具有可重复性（0.56 - 0.90）。游离液体的一致性极佳（0.85 - 1），而肠系膜肥厚的一致性总体较差（0.14 - 0.69）。狭窄的一致性极佳（0.81 - 1），瘘管在A房间的一致性一般（0.31 - 0.48），在B房间的一致性非常好（0.87 - 1）。
用于克罗恩病的肠道超声检查征象可以标准化，因为其中大多数显示出较好到良好的可重复性。特别是，肠壁厚度作为克罗恩病检测最相关的参数，显示出极佳的可重复性。
