Departments of Gastroenterology and Hepatology, Radiology, and Surgery, VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, the Netherlands.
Radiology. 2010 Mar;254(3):765-73. doi: 10.1148/radiol.09090828.
To evaluate the diagnostic accuracy and interobserver variance of magnetic resonance (MR) enteroclysis in the diagnosis of small-bowel neoplasms, with small-bowel endoscopy, surgery, histopathologic analysis, and follow-up serving as standards of reference, and to identify MR enteroclysis characteristics capable of enabling discrimination between benign and malignant small-bowel neoplasms.
This study was performed in accordance with the guidelines of the institutional review board, and the requirement for informed consent was waived. MR enteroclysis studies of 91 patients (43 women, 48 men; age range, 18-83 years) were retrospectively evaluated by two radiologists blinded to clinical details. Only studies explicitly performed to investigate or exclude the presence of small-bowel neoplasms were included. Radiologic findings were compared with findings of double-balloon endoscopy (n = 45), surgery (n = 18), esophagogastroduodenoscopy (n = 3), ileocolonoscopy (n = 2), autopsy (n = 2), and clinical follow-up for more than 18 months (n = 21). Efficacy parameters were calculated with 95% confidence intervals. Tumor characteristics were compared with the Student t test and the Fisher exact test.
Readers 1 and 2 interpreted 31 and 33 studies, respectively, as depicting a small-bowel neoplasm and 19 and 17 studies, respectively, as depicting small-bowel malignancy. In 32 patients, the presence of small-bowel neoplasm was confirmed. In 19 of these patients, the neoplasm was malignant. Sensitivity and specificity in the diagnosis of small-bowel neoplasms was 0.91 and 0.95, respectively, for reader 1 and 0.94 and 0.97, respectively, for reader 2; the kappa value was 0.95. Factors associated with malignancy were the presence of longer solitary nonpedunculated lesions, mesenteric fat infiltration, and enlarged mesenteric lymph nodes.
Eighty-six of 91 studies were correctly interpreted, resulting in an overall diagnostic accuracy of 0.95 for MR enteroclysis in the detection of small-bowel neoplasms.
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090828/-/DC1.
通过小肠内镜、手术、组织病理学分析和随访作为参考标准，评估磁共振肠造影术（MR 肠造影术）在诊断小肠肿瘤中的诊断准确性和观察者间差异，并确定能够区分良恶性小肠肿瘤的 MR 肠造影术特征。
本研究符合机构审查委员会的指导方针，且豁免了知情同意的要求。对两位放射科医生进行了回顾性评估，他们对临床细节不知情。仅包括明确进行以调查或排除小肠肿瘤的存在的研究。将影像学发现与双气囊内镜检查（n=45）、手术（n=18）、食管胃十二指肠镜检查（n=3）、回结肠镜检查（n=2）、尸检（n=2）和临床随访超过 18 个月（n=21）的结果进行比较。采用 95%置信区间计算疗效参数。使用学生 t 检验和 Fisher 确切检验比较肿瘤特征。
读者 1 和 2 分别解读了 31 项和 33 项研究，分别描述为存在小肠肿瘤，分别解读了 19 项和 17 项研究，分别描述为存在小肠恶性肿瘤。在 32 例患者中，证实存在小肠肿瘤。在这些患者中，有 19 例为恶性肿瘤。读者 1 诊断小肠肿瘤的灵敏度和特异性分别为 0.91 和 0.95，读者 2 分别为 0.94 和 0.97；kappa 值为 0.95。与恶性肿瘤相关的因素是存在较长的单发无蒂病变、肠系膜脂肪浸润和增大的肠系膜淋巴结。
91 项研究中有 86 项得到正确解读，MR 肠造影术对小肠肿瘤的检出具有 0.95 的总体诊断准确性。
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090828/-/DC1.
