Department of Radiology, The Ottawa Hospital, C-1, 1053 Carling Avenue, Ottawa, Ottawa, ON, Canada K1Y 4E9.
Gastroenterol Res Pract. 2012;2012:598418. doi: 10.1155/2012/598418. Epub 2011 Jun 20.
Crohn's disease affects any part of the GI tract, commonly the terminal ileum. To decrease radiation exposure we developed a low-radiation-dose unenhanced CT (modified small Bowel CT, MBCT) to evaluate the small bowel using hyperdense oral contrast. Technique. MBCT was investigated in patients with pathologically proven Crohn's disease presenting with new symptoms from recurrent inflammation or stricture. After ethics board approval, 98 consecutive patients were retrospectively evaluated. Kappa values from two independent reviewers were calculated for presence of obstruction, active inflammation versus chronic stricture, and ancillary findings. Forty-two patients underwent surgery or colonoscopy within 3 months. Results. Kappa was 0.84 for presence of abnormality versus a normal exam and 0.89 for differentiating active inflammation from chronic stricture. Level of agreement for presence of skip areas, abscess formation, and fistula was 0.62, 0.75, and 0.78, respectively. In the subset with "gold standard" follow-up, there was 83% agreement. Conclusions. MBCT is a low-radiation technique with good to very good interobserver agreement for determining presence of obstruction and degree of disease activity in patients with Crohn's disease. Further investigation is required to refine parameters of disease activity compared to CT enterography and small bowel follow through.
克罗恩病可影响胃肠道的任何部位，通常是末端回肠。为了减少辐射暴露，我们开发了一种低辐射剂量的非增强 CT（改良小肠 CT，MBCT），使用高浓度口服对比剂来评估小肠。方法。在出现新的炎症或狭窄复发症状的病理证实的克罗恩病患者中，研究了 MBCT。在获得伦理委员会批准后，回顾性评估了 98 例连续患者。由两名独立的审查员计算了存在梗阻、活动性炎症与慢性狭窄以及辅助发现的kappa 值。42 例患者在 3 个月内接受了手术或结肠镜检查。结果。异常存在与正常检查的kappa 值为 0.84，活动性炎症与慢性狭窄的区分kappa 值为 0.89。存在跳跃区、脓肿形成和瘘管的一致性水平分别为 0.62、0.75 和 0.78。在具有“金标准”随访的亚组中，存在 83%的一致性。结论。MBCT 是一种低辐射技术，对于确定克罗恩病患者的梗阻存在和疾病活动程度具有良好到非常好的观察者间一致性。需要进一步研究来比较与 CT 肠造影和小肠随访相比，MBCT 对疾病活动度的参数进行优化。
