Departments of Abdominal and Interventional Imaging and Digestive Diseases, Lariboisière-AP-HP-GHU Nord and Diderot-Paris 7 University, 2 rue Ambroise Paré, 75475 Paris cedex 10, France.
Radiology. 2010 Mar;254(3):755-64. doi: 10.1148/radiol.09091165.
To determine the utility of computed tomographic (CT) enteroclysis for characterization of the status of the anastomotic site in patients with Crohn disease who had previously undergone ileocolic resection.
Written informed consent was prospectively obtained from all patients, and the institutional review board approved the study protocol. CT enteroclysis findings in 40 patients with Crohn disease who had previously undergone ileocolic resection were evaluated independently by two readers. Endoscopic findings, histopathologic findings, and/or the Crohn disease activity index was the reference standard. Interobserver agreement between the two readers was calculated with kappa statistics. Associations between CT enteroclysis findings and anastomotic site status were assessed at univariate analysis. The sensitivity, specificity, and accuracy of CT enteroclysis, with corresponding 95% confidence intervals (CIs), for the diagnosis of normal versus abnormal anastomosis and the diagnosis of anastomotic recurrence versus fibrostenosis were estimated.
Interobserver agreement regarding CT enteroclysis criteria was good to perfect (kappa = 0.72-1.00). At univariate analysis, stratification and anastomotic wall thickening were the two most discriminating variables in the differentiation between normal and abnormal anastomoses (P < .001). Stratification (P < .001) and the comb sign (P = .026) were the two most discriminating variables in the differentiation between anastomotic recurrence and fibrostenosis. In the diagnosis of anastomotic recurrence, severe anastomotic stenosis was the most sensitive finding (95% [20 of 21 patients]; 95% CI: 76.18%, 99.88%), both comb sign and stratification had 95% specificity (18 of 19 patients; 95% CI: 73.97%, 99.87%), and stratification was the most accurate finding (92% [37 of 40 patients]; 95% CI: 79.61%, 98.43%). In the diagnosis of fibrostenosis, both severe anastomotic stenosis and anastomotic wall thickening were 100% sensitive (eight of eight patients; 95% CI: 63.06%, 100.00%), and using an association among five categorical variables, including severe anastomotic stenosis, anastomotic wall thickening with normal or mild mucosal enhancement, absence of comb sign, and absence of fistula, yielded 88% sensitivity (seven of eight patients; 95% CI: 47.35%, 99.68%), 97% specificity (31 of 32 patients; 95% CI: 83.78%, 99.92%), and 95% accuracy (38 of 40 patients; 95% CI: 83.08%, 99.39%).
CT enteroclysis yields objective and relatively specific morphologic criteria that help differentiate between recurrent disease and fibrostenosis at the anastomotic site after ileocolic resection for Crohn disease.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091165/-/DC1.
评估 CT 肠造影术对先前接受过回肠结肠切除术的克罗恩病患者吻合口状态的评估作用。
所有患者均前瞻性地签署了书面知情同意书，机构审查委员会批准了该研究方案。由两位读者独立评估 40 例先前接受过回肠结肠切除术的克罗恩病患者的 CT 肠造影检查结果。将内镜检查结果、组织病理学检查结果和（或）克罗恩病活动指数作为参考标准。采用 Kappa 统计法计算两位读者之间的观察者间一致性。采用单变量分析评估 CT 肠造影结果与吻合口状态之间的相关性。计算 CT 肠造影术诊断正常与异常吻合口以及诊断吻合口复发与纤维狭窄的敏感性、特异性和准确性，相应的 95%置信区间（CI）。
两位读者在 CT 肠造影标准的判断方面具有良好到极好的一致性（kappa 值为 0.72~1.00）。单变量分析显示，分层和吻合口壁增厚是区分正常和异常吻合口的两个最具鉴别性的变量（P<0.001）。分层（P<0.001）和梳状征（P=0.026）是区分吻合口复发和纤维狭窄的两个最具鉴别性的变量。在诊断吻合口复发时，严重的吻合口狭窄是最敏感的表现（95%[21 例患者中的 20 例]；95%CI：76.18%，99.88%），梳状征和分层均具有 95%的特异性（19 例患者中的 18 例；95%CI：73.97%，99.87%），而分层是最准确的表现（40 例患者中的 37 例；95%CI：79.61%，98.43%）。在诊断纤维狭窄时，严重的吻合口狭窄和吻合口壁增厚的敏感性均为 100%（8 例患者中的 8 例；95%CI：63.06%，100.00%），采用包括严重吻合口狭窄、吻合口壁增厚伴正常或轻度黏膜增强、无梳状征和无瘘管在内的 5 个分类变量的联合，其敏感性为 88%（8 例患者中的 7 例；95%CI：47.35%，99.68%），特异性为 97%（32 例患者中的 31 例；95%CI：83.78%，99.92%），准确性为 95%（40 例患者中的 38 例；95%CI：83.08%，99.39%）。
CT 肠造影术可提供客观且具有相对特异性的形态学标准，有助于区分回肠结肠切除术后克罗恩病患者吻合口处的复发疾病和纤维狭窄。
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091165/-/DC1.
