Punwani Shonit, Rodriguez-Justo Manuel, Bainbridge Alan, Greenhalgh Rebecca, De Vita Enrico, Bloom Stuart, Cohen Richard, Windsor Alastair, Obichere Austin, Hansmann Anika, Novelli Marco, Halligan Steve, Taylor Stuart A
Department of Specialist X Ray, University College London Hospitals National Health Service Foundation Trust, 235 Euston Rd, Podium Level 2, London NW1 2BU, England.
Radiology. 2009 Sep;252(3):712-20. doi: 10.1148/radiol.2523082167. Epub 2009 Jul 27.
To validate proposed magnetic resonance (MR) imaging features of Crohn disease activity against a histopathologic reference.
Ethical permission was given by the University College London hospital ethics committee, and informed written consent was obtained from all participants. Preoperative MR imaging was performed in 18 consecutive patients with Crohn disease undergoing elective small-bowel resection. The Harvey-Bradshaw index, the C-reactive protein level, and disease chronicity were recorded. The resected bowel was retrospectively identified at preoperative MR imaging, and wall thickness, mural and lymph node/cerebrospinal fluid (CSF) signal intensity ratios on T2-weighted fat-saturated images, gadolinium-based contrast material uptake, enhancement pattern, and mesenteric signal intensity on T2-weighted fat-saturated images were recorded. Precise histologic matching was achieved by imaging the ex vivo surgical specimens. Histopathologic grading of acute inflammation with the acute inflammatory score (AIS) (on the basis of mucosal ulceration, edema, and quantity and depth of neutrophilic infiltration) and the degree of fibrostenosis was performed at each site, and results were compared with MR imaging features. Data were analyzed by using linear regression with robust standard errors of the estimate.
AIS was positively correlated with mural thickness and mural/CSF signal intensity ratio on T2-weighted fat-saturated images (P < .001 and P = .003, respectively) but not with mural enhancement at 30 and 70 seconds (P = .50 and P = .73, respectively). AIS was higher with layered mural enhancement (P < .001), a pattern also commonly associated with coexisting fibrostenosis (75%). Mural/CSF signal intensity ratio on T2-weighted fat-saturated images was higher in histologically edematous bowel than in nonedematous bowel (P = .04). There was no correlation between any lymph node characteristic and AIS.
Increasing mural thickness, high mural signal intensity on T2-weighted fat-saturated images, and a layered pattern of enhancement reflect histologic features of acute small-bowel inflammation in Crohn disease.
对照组织病理学参考标准，验证所提出的克罗恩病活动度的磁共振（MR）成像特征。
获得伦敦大学学院医院伦理委员会的伦理许可，并取得所有参与者的书面知情同意书。对18例接受择期小肠切除术的克罗恩病患者进行术前MR成像检查。记录哈维-布拉德肖指数、C反应蛋白水平和疾病病程。在术前MR成像中回顾性识别切除的肠段，并记录T2加权脂肪抑制图像上的肠壁厚度、肠壁与淋巴结/脑脊液（CSF）信号强度比、钆对比剂摄取、强化模式以及T2加权脂肪抑制图像上的肠系膜信号强度。通过对离体手术标本成像实现精确的组织学匹配。在每个部位进行基于急性炎症评分（AIS）（基于黏膜溃疡、水肿以及中性粒细胞浸润的数量和深度）的急性炎症组织病理学分级和纤维狭窄程度分级，并将结果与MR成像特征进行比较。采用具有稳健估计标准误的线性回归分析数据。
AIS与T2加权脂肪抑制图像上的肠壁厚度和肠壁/CSF信号强度比呈正相关（分别为P <.001和P =.003），但与30秒和70秒时的肠壁强化无关（分别为P =.50和P =.73）。分层肠壁强化时AIS更高（P <.001），这种模式也通常与并存的纤维狭窄相关（75%）。组织学上有水肿的肠段在T2加权脂肪抑制图像上的肠壁/CSF信号强度比高于无水肿的肠段（P =.04）。任何淋巴结特征与AIS之间均无相关性。
肠壁厚度增加、T2加权脂肪抑制图像上肠壁信号强度高以及分层强化模式反映了克罗恩病急性小肠炎症的组织学特征。
