Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
Inflamm Bowel Dis. 2011 Mar;17(3):778-86. doi: 10.1002/ibd.21364.
The purpose was to validate a lower radiation dose computed tomography enterography (CTE) imaging protocol to detect the presence of Crohn's disease (CD) in the small bowel using two different reference standards and to identify a prediction model based on CTE signs for the presence of active CD.
This retrospective study included patients with known or suspected CD who underwent CTE between January and October 2006 according to a lower radiation dose protocol. Two gastrointestinal radiologists blindly and independently classified each CTE as being active or inactive. Reference standards included ileocolonoscopy ± biopsy and a comprehensive clinical reference standard (retrospectively created by a gastroenterologist, also including history, physical, follow-up course, and subsequent endoscopy, imaging, or surgery). Logistic regression was used to identify CTE findings that predicted the presence of active CD based on the combined clinical reference standard.
In all, 137 patients underwent CTE and ileocolonoscopy. Using an endoscopic reference standard, the sensitivity of CTE to detect active CD for the two readers was 81% and 89%, respectively. Using the clinical reference standard, the sensitivity of CTE to detect active CD was 89% and 98%, respectively. For both readers the sensitivity of CTE increased by 8%-9% when using the comprehensive reference standard. Multivariate analysis showed that a combination of mural thickness and hyperenhancement best predicted active CD (area under the curve [AUC] = 0.92-0.93, P < 0.0001).
Lower radiation dose CTE exams are sensitive for the detection of active small bowel CD. The combination of mural thickness and hyperenhancement are the best radiologic predictors of active CD.
本研究旨在验证一种低剂量 CT 肠造影（CTE）成像方案，通过两种不同的参考标准来检测小肠克罗恩病（CD）的存在，并基于 CTE 征象建立预测模型来判断疾病的活动度。
本回顾性研究纳入了 2006 年 1 月至 10 月期间按照低剂量方案行 CTE 检查且已知或疑似患有 CD 的患者。两名胃肠放射科医生对每例 CTE 检查结果进行独立、盲法评估，判断其是否处于活动期。参考标准包括回结肠镜检查和活检，以及由胃肠病医生创建的综合临床参考标准（包括病史、体格检查、随访情况、后续内镜、影像学或手术结果）。采用 Logistic 回归分析确定 CTE 影像学表现与基于综合临床参考标准的活动期 CD 之间的相关性。
共 137 例患者接受了 CTE 和回结肠镜检查。使用内镜参考标准，两位读者判断 CTE 检出活动期 CD 的敏感度分别为 81%和 89%。使用临床参考标准，CTE 检出活动期 CD 的敏感度分别为 89%和 98%。当使用综合参考标准时，两位读者的 CTE 敏感度分别提高了 8%和 9%。多变量分析显示，肠壁厚度和强化程度的联合可较好地预测疾病活动度（曲线下面积[AUC]为 0.92-0.93，P<0.0001）。
低剂量 CTE 检查对小肠 CD 活动期的检出具有较高的敏感度。肠壁厚度和强化程度的联合是预测 CD 活动度的最佳影像学指标。
