Division of Gastroenterology & Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Inflamm Bowel Dis. 2012 Feb;18(2):219-25. doi: 10.1002/ibd.21683. Epub 2011 Feb 17.
Computed tomographic enterography (CTE) has been shown to have a high sensitivity and specificity for active small bowel inflammation. There are only sparse data on the effect of CTE results on Crohn's disease (CD) patient care.
We prospectively assessed 273 patients with established or suspected CD undergoing a clinically indicated CTE. Providers were asked to complete pre- and postimaging questionnaires regarding proposed clinical management plans and physician level of confidence (LOC) for the presence or absence of active small bowel disease, fistula(s), abscess(es), or stricturing disease. Correlative clinical, serologic, and histologic data were recorded. Following revelation of CTE results, providers were questioned if CTE altered their management plans, and whether LOC changes were due to CTE findings (on a 5-point scale).
CTE altered management plans in 139 cases (51%). CTE changed management in 70 (48%) of those with established disease, prompting medication changes in 35 (24%). Management changes were made post-CTE in 69 (54%) of those with suspected CD, predominantly due to excluding CD (36%). CTE-perceived changes in management were independent of clinical, serologic, and histologic findings (P < 0.0001). Clinically meaningful LOC changes (2 or more points) were observed in 212 (78%).
CTE is a clinically useful examination, altering management plans in nearly half of patients with CD, while increasing physician LOC for the detection of small bowel inflammation and penetrating disease. These findings further support the use of CTE in CD management algorithms.
计算机断层扫描小肠造影（CTE）在诊断活动性小肠炎症方面具有较高的灵敏度和特异性。目前关于 CTE 结果对克罗恩病（CD）患者治疗的影响的数据很少。
我们前瞻性评估了 273 例经临床指征进行 CTE 的确诊或疑似 CD 患者。在进行 CTE 前后，医生需要完成有关拟议临床管理计划和医生对存在或不存在活动性小肠疾病、瘘管、脓肿或狭窄性疾病的信心（LOC）的调查问卷。记录相关的临床、血清学和组织学数据。在揭示 CTE 结果后，医生被询问 CTE 是否改变了他们的管理计划，以及 LOC 的变化是否是由于 CTE 发现（采用 5 分制）。
139 例（51%）CTE 改变了治疗方案。在 70 例（48%）确诊疾病患者中改变了治疗方案，其中 35 例（24%）需要改变药物治疗。在 69 例（54%）疑似 CD 患者中，CTE 改变了治疗方案，主要是因为排除了 CD（36%）。CTE 认为的管理变化与临床、血清学和组织学发现无关（P<0.0001）。观察到 212 例（78%）临床意义上的 LOC 变化（2 分或以上）。
CTE 是一种临床有用的检查，可改变近一半 CD 患者的治疗方案，同时提高医生对小肠炎症和穿透性疾病的检测能力。这些发现进一步支持在 CD 管理算法中使用 CTE。
