Goetz M, Neurath M F
I. Med. Clinic, Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany.
Gastroenterol Clin Biol. 2009 Jun;33 Suppl 3:S174-82. doi: 10.1016/S0399-8320(09)73152-5.
Imaging techniques have undergone substantial progress in recent years and contribute significantly in the diagnosis of inflammatory bowel diseases in conjunction with patient history, clinical and laboratory examination. Modern cross-sectional imaging modalities such as computed tomography and magnetic resonance imaging allow an evaluation not only of the complete bowel wall of the small intestine, but also of extraluminal structures. They constitute a major diagnostic component in the initial workup, in stricturing or fistulizing disease and in suspected abscess. Transabdominal ultrasonography has been re-appreciated in these settings as an easy- and ready-to-use tool yielding real-time information. Positron emission tomography was found useful to add functional diagnosis of inflammation. Colonoscopy techniques still represent the gold standard for evaluation of inflammatory activity and for cancer surveillance. Here, chromoendoscopy has proven efficacy for enhanced detection of flat intraepithelial neoplasias in ulcerative colitis and has been incorporated into recent surveillance guidelines. Narrow band imaging may provide virtual chromoendoscopy in the future, but confirmatory studies are still on the way. Confocal endomicroscopy allows in vivo microscopy at high resolution and with excellent accuracy in first trials to predict histology of inflammatory and neoplastic lesions. The current data from endoscopic studies should result in an integrated approach to both identify and characterize a suspicious lesion during ongoing endoscopy for reliable, accurate diagnosis and targeted, immediate therapy.
近年来，成像技术取得了长足的进步，结合患者病史、临床和实验室检查，在炎症性肠病的诊断中发挥了重要作用。现代横断面成像方式，如计算机断层扫描和磁共振成像，不仅可以评估小肠的完整肠壁，还可以评估肠外结构。它们是初始检查、狭窄或瘘管形成疾病以及疑似脓肿诊断的主要组成部分。在这些情况下，经腹超声检查作为一种易于使用且能提供实时信息的工具，重新受到重视。正电子发射断层扫描被发现有助于增加炎症的功能诊断。结肠镜检查技术仍然是评估炎症活动和癌症监测的金标准。在此，色素内镜检查已被证明在增强溃疡性结肠炎扁平上皮内瘤变的检测方面有效，并已纳入近期的监测指南。窄带成像未来可能提供虚拟色素内镜检查，但验证性研究仍在进行中。共聚焦内镜显微镜在初步试验中能够以高分辨率和极高的准确性进行体内显微镜检查，以预测炎症和肿瘤性病变的组织学。目前来自内镜研究的数据应促成一种综合方法，即在进行中的内镜检查期间识别和表征可疑病变，以实现可靠、准确的诊断和有针对性的即时治疗。
