Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Inflamm Bowel Dis. 2010 Sep;16(9):1526-31. doi: 10.1002/ibd.21199.
Computerized tomography enterography (CTE), gastrograffin enema (GGE), magnetic resonance imaging (MRI), and pouch endoscopy (PES) have commonly been used to assess ileal pouch disorders. However, their diagnostic utility has not been systematically evaluated. The aims of this study were to compare these imaging techniques to each other and to optimize diagnosis of pouch disorders by using a combination of these diagnostic modalities.
Clinical data of patients from the Pouchitis Clinic from 2003 to 2008 who had a PES and at least 1 additional imaging modalities (CTE, GGE, or MRI) used for evaluation of ileal pouch disorders were retrospectively evaluated. We analyzed the accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) with which these tests were able diagnose pouch inlet and distal small bowel and pouch outlet strictures, pouch fistulas, sinuses, and leaks. Subsequently, accuracy was recalculated by combining 2 imaging modalities to see if this could enhance accuracy.
A total of 66 patients underwent evaluation with PES and 1 other imaging modality as follows: PES + CTE (n = 23), PES + GGE (n = 34), and PES + MRI (n = 26). The mean age was 41.5 +/- 14.5 years, with 28 being female (42.4%). Sixty patients (90.9%) had J pouches and 59 (89.4%) had a preoperative diagnosis of ulcerative colitis. Overall, CTE, GGE, MRI, and PES all had reasonable accuracy for the diagnosis of small bowel and inlet strictures (73.9%-95.4%), outlet strictures (87.9%-92.3%), fistula (76.9%-84.8%), sinus (68.0%-93.9%), and pouch leak (83-93.9%). CTE had the lowest accuracy for small bowel and inlet strictures (73.9%) and MRI had the lowest accuracy for pouch sinus (68.0%). Combining 2 imaging tests can increase the accuracy of diagnosis to 100% for strictures, fistulas, sinus, and pouch leaks.
CTE, GGE, MRI, and PES offer complementary information on disorders of the pouch and the combination of these tests increases diagnostic accuracy for complex cases.
计算机断层扫描肠造影术（CTE）、胃造影灌肠（GGE）、磁共振成像（MRI）和袋内镜（PES）常用于评估回肠袋疾病。然而，它们的诊断效用尚未系统评估。本研究的目的是相互比较这些影像学技术，并通过组合这些诊断方式来优化对袋疾病的诊断。
回顾性分析 2003 年至 2008 年在袋炎诊所就诊的患者的临床数据，这些患者进行了 PES 检查，并至少使用了 1 种额外的影像学方法（CTE、GGE 或 MRI）来评估回肠袋疾病。我们分析了这些检查诊断回肠入口和远端小肠以及袋出口狭窄、袋瘘、窦和漏的准确性、敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。随后，通过组合 2 种影像学方法重新计算准确性，以观察是否可以提高准确性。
共有 66 例患者接受 PES 和 1 种其他影像学检查评估，具体如下：PES+CTE（n=23）、PES+GGE（n=34）和 PES+MRI（n=26）。平均年龄为 41.5±14.5 岁，女性 28 例（42.4%）。60 例（90.9%）为 J 袋，59 例（89.4%）术前诊断为溃疡性结肠炎。总的来说，CTE、GGE、MRI 和 PES 对诊断小肠和入口狭窄（73.9%-95.4%）、出口狭窄（87.9%-92.3%）、瘘（76.9%-84.8%）、窦（68.0%-93.9%）和袋漏（83%-93.9%）均具有合理的准确性。CTE 对小肠和入口狭窄的准确性最低（73.9%），MRI 对袋窦的准确性最低（68.0%）。结合 2 种影像学检查可将狭窄、瘘、窦和袋漏的诊断准确性提高至 100%。
CTE、GGE、MRI 和 PES 提供了对袋疾病的互补信息，这些检查的组合可提高复杂病例的诊断准确性。
