Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
Gut. 2010 Aug;59(8):1056-65. doi: 10.1136/gut.2009.197665. Epub 2010 Jun 4.
Magnetic resonance imaging (MRI) enables accurate assessment of inflammatory bowel diseases (IBD), but its main limitation is the need for bowel preparation. Diffusion-weighted imaging is feasible in Crohn's disease. We evaluated the accuracy of MRI in combination with diffusion-weighted imaging (DWI-MRI) without oral or rectal preparation in assessing colonic inflammation in both ulcerative colitis and Crohn's disease.
This was an observational study of a single-centre cohort.
All patients who underwent DWI-MRI-colonography without bowel preparation between January 2008 and February 2010 in our centre were analysed.
Among the 96 patients (ulcerative colitis=35; Crohn's disease=61) who had DWI-MRI-colonography, 68 had concomitant endoscopy. In ulcerative colitis a segmental magnetic resonance score (MR-score-S) >1 detected endoscopic inflammation with a sensitivity and specificity of 89.47% and 86.67%, respectively (AUROC=0.920, p=0.0001). In the Crohn's disease group, a MR-score-S >2 detected endoscopic inflammation in the colon with a sensitivity and specificity of 58.33% and 84.48%, respectively (AUROC=0.779, p=0.0001). The MR-score-S demonstrated better accuracy for the detection of endoscopic inflammation in the ulcerative colitis group than in the Crohn's disease group (p=0.003). In ulcerative colitis, the proposed total magnetic resonance score (MR-score-T) correlated with the total modified Baron score (r=0.813, p=0.0001) and the Walmsley index (r=0.678, p<0.0001). In Crohn's disease, the MR-score-T correlated with the simplified endoscopic activity score for Crohn's disease (r=0.539, p=0.001) and the Crohn's disease activity index (r=0.367, p=0.004). The DWI hyperintensity was a predictor of colonic endoscopic inflammation in ulcerative colitis (OR=13.26, 95% CI 3.6 to 48.93; AUROC=0.854, p=0.0001) and Crohn's disease (OR=2.67, 95% CI 1.25 to 5.72; AUROC=0.702, p=0.0001). The accuracy of the DWI hyperintensity for detecting colonic inflammation was greater in ulcerative colitis than in Crohn's disease (p=0.004).
DWI-MRI-colonography without bowel preparation is a reliable tool for detecting colonic inflammation in ulcerative colitis.
磁共振成像（MRI）能够准确评估炎症性肠病（IBD），但它的主要局限性是需要肠道准备。弥散加权成像在克罗恩病中是可行的。我们评估了在溃疡性结肠炎和克罗恩病中，不进行口服或直肠准备的情况下，结合弥散加权成像（DWI-MRI）进行 MRI 检查评估结肠炎症的准确性。
这是一项单中心队列的观察性研究。
我们分析了 2008 年 1 月至 2010 年 2 月期间在我们中心接受 DWI-MRI 结肠检查且未进行肠道准备的所有患者。
在 96 例接受 DWI-MRI 结肠检查的患者（溃疡性结肠炎=35 例；克罗恩病=61 例）中，68 例同时进行了内镜检查。在溃疡性结肠炎中，节段性磁共振评分（MR-score-S）>1 检测到内镜炎症的敏感性和特异性分别为 89.47%和 86.67%（AUROC=0.920，p=0.0001）。在克罗恩病组中，MR-score-S>2 检测到结肠内镜炎症的敏感性和特异性分别为 58.33%和 84.48%（AUROC=0.779，p=0.0001）。MR-score-S 对溃疡性结肠炎组的内镜炎症检测的准确性优于克罗恩病组（p=0.003）。在溃疡性结肠炎中，提出的总磁共振评分（MR-score-T）与总改良 Baron 评分（r=0.813，p=0.0001）和 Walmsley 指数（r=0.678，p<0.0001）相关。在克罗恩病中，MR-score-T 与简化克罗恩病活动评分（r=0.539，p=0.001）和克罗恩病活动指数（r=0.367，p=0.004）相关。DWI 高信号是溃疡性结肠炎（OR=13.26，95%CI 3.6 至 48.93；AUROC=0.854，p=0.0001）和克罗恩病（OR=2.67，95%CI 1.25 至 5.72；AUROC=0.702，p=0.0001）中结肠内镜炎症的预测因子。DWI 高信号检测结肠炎症的准确性在溃疡性结肠炎中优于克罗恩病（p=0.004）。
不进行肠道准备的 DWI-MRI 结肠检查是一种可靠的工具，可用于检测溃疡性结肠炎中的结肠炎症。
