Siddiki Hassan A, Fidler Jeff L, Fletcher Joel G, Burton Sharon S, Huprich James E, Hough David M, Johnson C Daniel, Bruining David H, Loftus Edward V, Sandborn William J, Pardi Darrell S, Mandrekar Jayawant N
Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN 55905, USA.
AJR Am J Roentgenol. 2009 Jul;193(1):113-21. doi: 10.2214/AJR.08.2027.
The objective of our study was to prospectively obtain pilot data on the accuracy of MR enterography for detecting small-bowel Crohn's disease compared with CT enterography and with a clinical reference standard based on imaging, clinical information, and ileocolonoscopy.
The study group for this blinded prospective study was composed of 33 patients with suspected active Crohn's ileal inflammation who were scheduled for clinical CT enterography and ileocolonoscopy and had consented to also undergo MR enterography. The MR enterography and CT enterography examinations were each interpreted by two radiologists with disagreements resolved by consensus. The reports from ileocolonoscopy with or without mucosal biopsy were interpreted by a gastroenterologist. The reference standard for the presence of small-bowel Crohn's disease was based on the final clinical diagnosis by the referring gastroenterologist after reviewing all of the available information.
All 33 patients underwent CT enterography and ileocolonoscopy, 30 of whom also underwent MR enterography. The sensitivities of MR enterography and CT enterography for detecting active small-bowel Crohn's disease were similar (90.5% vs 95.2%, respectively; p = 0.32). The image quality scores for MR enterography examinations were significantly lower than those for CT enterography (p = 0.005). MR enterography and CT enterography identified eight cases (24%) with a final diagnosis of active small-bowel inflammation in which the ileal mucosa appeared normal at ileocolonoscopy. Furthermore, enterography provided the only available imaging in three additional patients who did not have ileal intubation.
MR enterography and CT enterography have similar sensitivities for detecting active small-bowel inflammation, but image quality across the study cohort was better with CT. Cross-sectional enterography provides complementary information to ileocolonoscopy.
我们研究的目的是前瞻性地获取有关磁共振小肠造影(MR enterography)检测小肠克罗恩病准确性的初步数据,并与CT小肠造影以及基于影像学、临床信息和回结肠镜检查的临床参考标准进行比较。
这项双盲前瞻性研究的研究组由33例疑似活动性克罗恩回肠炎患者组成,这些患者计划接受临床CT小肠造影和回结肠镜检查,并已同意同时接受MR小肠造影。MR小肠造影和CT小肠造影检查分别由两名放射科医生解读,分歧通过达成共识解决。有无黏膜活检的回结肠镜检查报告由一名胃肠病学家解读。小肠克罗恩病存在与否的参考标准基于转诊胃肠病学家在审查所有可用信息后的最终临床诊断。
所有33例患者均接受了CT小肠造影和回结肠镜检查,其中30例还接受了MR小肠造影。MR小肠造影和CT小肠造影检测活动性小肠克罗恩病的敏感性相似(分别为90.5%和95.2%;p = 0.32)。MR小肠造影检查的图像质量评分显著低于CT小肠造影(p = 0.005)。MR小肠造影和CT小肠造影发现8例(24%)最终诊断为活动性小肠炎症的病例,这些病例在回结肠镜检查时回肠黏膜外观正常。此外,小肠造影为另外3例未进行回肠插管的患者提供了唯一可用的影像学检查。
MR小肠造影和CT小肠造影在检测活动性小肠炎症方面具有相似的敏感性,但整个研究队列中CT的图像质量更好。横断面小肠造影可为回结肠镜检查提供补充信息。