克罗恩病：对比增强超声检查结果与内镜检查严重程度的相关性

Crohn disease: correlation of findings at contrast-enhanced US with severity at endoscopy.

作者信息

Ripollés Tomás, Martínez María J, Paredes Jose M, Blanc Esther, Flors Lucía, Delgado Fructuoso

机构信息

Department of Radiology, Hospital Universitario Dr Peset, 46017 Valencia, Spain.

出版信息

Radiology. 2009 Oct;253(1):241-8. doi: 10.1148/radiol.2531082269. Epub 2009 Jul 27.

DOI:10.1148/radiol.2531082269

PMID:19635834

Abstract

PURPOSE

To evaluate the effectiveness of visualization of vascularization at contrast material-enhanced ultrasonography (US) for assessment of the activity of Crohn disease, with severity grade determined at endoscopy as the reference standard.

MATERIALS AND METHODS

Ethics committee approval and written informed consent were obtained. Sixty-one patients (age range, 21-67 years; median age, 36 years) who had Crohn disease underwent both colonoscopy and US, including color Doppler and contrast-enhanced US, prospectively. To assess the vascularization of the involved bowel loop in a region expected to be seen at colonoscopy, the contrast agent uptake was measured by using quantitative analysis of the enhancement in regions of interest. Measurement of contrast enhancement was assessed as the increase in wall brightness with respect to the baseline brightness. Results were compared with the severity grade determined at endoscopy by using the area under the receiver operating characteristic curve and logistic regression analysis.

RESULTS

Colonoscopy showed inflammatory lesions in 53 patients (mild disease, seven; moderate disease, 12; and severe disease, 34). Bowel wall thickness and grade at color Doppler US (P = .019 and .002, respectively) correlated with severity grade at endoscopy. Mural contrast enhancement in patients with active disease at endoscopy was markedly increased in comparison with enhancement in patients with inactive disease (P < .001). Multivariate logistic regression analysis revealed that an increase in wall brightness was a significant and independent variable predictive of severity grade at endoscopy. A threshold brightness value of percentage of increase of 46% had a sensitivity and specificity of 96% and 73%, respectively, in the prediction of moderate or severe grade for inflammation at endoscopy.

CONCLUSION

Quantitative measurements of bowel enhancement obtained by using contrast-enhanced US correlate with severity grade determined at endoscopy. Contrast-enhanced US could be a useful technique to monitor the activity of Crohn disease.

SUPPLEMENTAL MATERIAL

http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082269/-/DC1.

摘要

目的

以结肠镜检查确定的严重程度分级为参考标准，评估对比增强超声（US）血管成像对克罗恩病活动度评估的有效性。

材料与方法

获得伦理委员会批准及书面知情同意。61例（年龄范围21 - 67岁；中位年龄36岁）克罗恩病患者前瞻性地接受了结肠镜检查和超声检查，包括彩色多普勒超声及对比增强超声。为评估预期在结肠镜检查中可见区域内受累肠袢的血管化情况，通过对感兴趣区域增强情况进行定量分析来测量造影剂摄取。对比增强测量评估为壁亮度相对于基线亮度的增加。使用受试者操作特征曲线下面积和逻辑回归分析将结果与结肠镜检查确定的严重程度分级进行比较。

结果

结肠镜检查显示53例患者存在炎症性病变（轻度疾病7例；中度疾病12例；重度疾病34例）。彩色多普勒超声的肠壁厚度和分级（分别为P = 0.019和0.002）与结肠镜检查的严重程度分级相关。与非活动性疾病患者相比，内镜检查显示为活动性疾病患者的壁对比增强明显增加（P < 0.001）。多变量逻辑回归分析显示，壁亮度增加是预测结肠镜检查严重程度分级的显著且独立变量。在预测内镜检查中炎症的中度或重度分级时，增加百分比的阈值亮度值46%的敏感度和特异度分别为96%和73%。