Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark.
Inflamm Bowel Dis. 2011 May;17(5):1081-8. doi: 10.1002/ibd.21534. Epub 2010 Nov 15.
Magnetic resonance enterography (MRE) and computed tomography enterography (CTE) visualizes small bowel Crohn's disease (CD) and its complications with high accuracy. The aim of this study was to determine the interobserver and intermodality agreement for detection of small bowel CD.
Fifty patients with suspected or known CD were included in the study and all patients underwent MRE and CTE on the same day. Four radiologists with experience in MRE and CTE techniques participated. Observers were blind to patient histories, results of ileocolonoscopies, and other small bowel examinations. Readers assessed the image quality, the presence of small bowel CD, and seven findings consistent with CD.
The image quality was better with CTE than MRE (P < 0.001) but the diagnostic yields were comparable (P = 0.4). For detection of small bowel CD, the interobserver agreement was substantial in CTE (κ = 0.64) and moderate in MRE (κ = 0.48). The intermodality agreement was fair to substantial (κ = 0.40-0.64) for different observers. Two abscesses were detected and confirmed at subsequent surgery. One abscess was not detected with MRE and only recorded by two observers in CTE. A total of 10 fistulas were detected: three were confirmed at subsequent surgery and four were false-positive findings.
MRE and CTE have comparable diagnostic yields in patients with suspected or known CD. However, CTE provides better image quality and interobserver agreement. In a substantial number of patients the diagnosis of small bowel CD is observer- and modality-dependent.
磁共振肠造影术（MRE）和计算机断层肠造影术（CTE）能够高度准确地可视化小肠克罗恩病（CD）及其并发症。本研究旨在确定用于检测小肠 CD 的观察者间和模态间一致性。
本研究纳入了 50 名疑似或已知 CD 的患者，所有患者均在同一天接受了 MRE 和 CTE 检查。四位具有 MRE 和 CTE 技术经验的放射科医生参与了研究。观察者对患者病史、回结肠镜检查结果和其他小肠检查结果均不知情。读者评估了图像质量、小肠 CD 的存在情况以及七种与 CD 一致的发现。
CTE 的图像质量优于 MRE（P<0.001），但诊断效果相当（P=0.4）。对于小肠 CD 的检测，CTE 的观察者间一致性为中等（κ=0.64），MRE 为中等（κ=0.48）。不同观察者之间的模态间一致性为适度至高度（κ=0.40-0.64）。检测到两个脓肿，并在随后的手术中得到证实。一个脓肿在 MRE 中未被发现，仅在 CTE 中被两位观察者记录。总共检测到 10 个瘘管：其中 3 个在随后的手术中得到证实，4 个为假阳性发现。
在疑似或已知 CD 的患者中，MRE 和 CTE 的诊断效果相当。然而，CTE 提供了更好的图像质量和观察者间一致性。在相当数量的患者中，小肠 CD 的诊断依赖于观察者和模态。
