小肠肿瘤：磁共振小肠造影的前瞻性评估

Small-bowel neoplasms: prospective evaluation of MR enteroclysis.

作者信息

Masselli Gabriele, Polettini Elisabetta, Casciani Emanuele, Bertini Luca, Vecchioli Amorino, Gualdi Gianfranco

机构信息

Department of Radiology, Umberto I Hospital, La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy.

出版信息

Radiology. 2009 Jun;251(3):743-50. doi: 10.1148/radiol.2513081819. Epub 2009 Mar 20.

DOI:10.1148/radiol.2513081819

PMID:19304922

Abstract

PURPOSE

To prospectively evaluate the accuracy of magnetic resonance (MR) enteroclysis in the detection of small-bowel neoplasms in symptomatic patients, with conventional endoscopy, tissue specimen, capsule endoscopy, conventional enteroclysis, and follow-up findings as reference standards.

MATERIALS AND METHODS

The study protocol was approved by the human research committee, and all patients gave written informed consent. One hundred fifty patients (83 male, 67 female; mean age, 42.6 years; age range, 17-84 years) who were clinically suspected of having small-bowel neoplasm and whose previous upper and lower gastrointestinal endoscopy findings were normal underwent MR enteroclysis. The MR enteroclysis findings were prospectively evaluated for the presence of focal bowel wall thickening, small-bowel masses, and small-bowel stenosis. Positive MR enteroclysis findings were compared with histopathologic examination results obtained after surgical (n = 19) or endoscopic (n = 2) procedures. Negative MR enteroclysis results were compared with the results of enteroscopy (n = 5), capsule endoscopy (n = 53), or conventional enteroclysis with subsequent clinical follow-up (n = 71). The diagnostic performance of MR enteroclysis was analyzed on a per-patient basis.

RESULTS

MR enteroclysis was successfully completed in all 150 patients and enabled correct detection of 19 small-bowel neoplasms, which were confirmed at histopathologic examination: three carcinoid neoplasms, two adenocarcinomas, two stromal tumors, five lymphomas, one angiomatous mass, three small-bowel metastases, one leiomyoma, one adenoma, and one lipoma. Overall sensitivity, specificity, and accuracy in identifying patients with small-bowel lesions were 86% (19 of 22), 98% (126 of 128), and 97% (145 of 150), respectively. Two MR enteroclysis examinations yielded false-positive findings, and three yielded false-negative findings.

CONCLUSION

MR enteroclysis is an accurate modality for detecting small-bowel neoplasms in symptomatic patients.

摘要

目的

以前瞻性方式评估磁共振（MR）小肠造影在有症状患者中检测小肠肿瘤的准确性，以传统内镜检查、组织标本、胶囊内镜检查、传统小肠造影及随访结果作为参考标准。

材料与方法

本研究方案获人类研究委员会批准，所有患者均签署书面知情同意书。150例临床怀疑患有小肠肿瘤且既往上、下消化道内镜检查结果正常的患者（男性83例，女性67例；平均年龄42.6岁；年龄范围17 - 84岁）接受了MR小肠造影检查。对MR小肠造影结果进行前瞻性评估，以确定是否存在局灶性肠壁增厚、小肠肿物及小肠狭窄。将MR小肠造影阳性结果与手术（n = 19）或内镜检查（n = 2）后获得的组织病理学检查结果进行比较。将MR小肠造影阴性结果与小肠镜检查（n = 5）、胶囊内镜检查（n = 53）或传统小肠造影及后续临床随访（n = 71）结果进行比较。基于每位患者分析MR小肠造影的诊断性能。

结果

150例患者均成功完成MR小肠造影检查，正确检测出19例小肠肿瘤，经组织病理学检查确诊：3例类癌肿瘤、2例腺癌、2例间质瘤、5例淋巴瘤、1例血管瘤样肿物、3例小肠转移瘤、1例平滑肌瘤、1例腺瘤和1例脂肪瘤。在识别小肠病变患者方面，总体敏感性、特异性和准确性分别为86%（22例中的19例）、98%（128例中的126例）和97%（150例中的145例）。2例MR小肠造影检查结果为假阳性，3例为假阴性。