弥散加权磁共振成像无需肠道准备即可检测炎症性肠病中的结肠炎症。

Diffusion-weighted magnetic resonance without bowel preparation for detecting colonic inflammation in inflammatory bowel disease.

机构信息

Inserm, U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.

出版信息

Gut. 2010 Aug;59(8):1056-65. doi: 10.1136/gut.2009.197665. Epub 2010 Jun 4.

DOI:10.1136/gut.2009.197665

PMID:20525970

Abstract

OBJECTIVE

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.

DESIGN

This was an observational study of a single-centre cohort.

PATIENTS

All patients who underwent DWI-MRI-colonography without bowel preparation between January 2008 and February 2010 in our centre were analysed.

RESULTS

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).

CONCLUSIONS

DWI-MRI-colonography without bowel preparation is a reliable tool for detecting colonic inflammation in ulcerative colitis.

摘要

目的

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。

设计

这是一项单中心队列的观察性研究。

患者

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。

结果

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）。