Jensen Michael Dam, Kjeldsen Jens, Rafaelsen Søren Rafael, Nathan Torben
Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital Vejle, Kabbeltoft 25, Vejle, Denmark.
Scand J Gastroenterol. 2011 Dec;46(12):1449-57. doi: 10.3109/00365521.2011.613947. Epub 2011 Sep 12.
In patients, with symptomatic Crohn's disease (CD), valid information about the presence or absence of small bowel disease activity and stenosis is clinically important. Such information supports decisions about medical or surgical therapy and can be obtained with MR enterography (MRE) or CT enterography (CTE).
A total of 50 patients with symptomatic pre-existing CD and a demand for small bowel imaging to support changes in treatment strategy were included in this prospective and blinded study. MRE and CTE were performed on the same day in alternating order and subsequently compared with the gold standard: pre-defined lesions at ileoscopy (n = 30) or surgery with (n = 12) or without (n = 3) intra-operative enteroscopy.
A total of 35 patients had active small bowel CD (jejunum 0, ileum 1, (neo)-terminal ileum 34) and 20 had small bowel stenosis. The sensitivity and specificity of MRE for detection of small bowel CD was 74% and 80% compared to 83% and 70% with CTE (p ≥ 0.5). MRE and CTE detected small bowel stenosis with 55% and 70% sensitivities, respectively (p = 0.3) and 92% specificities.
MRE and CTE have comparable diagnostic accuracies for detection of small bowel CD and stenosis. In symptomatic patients with CD and high disease prevalence, positive predictive values are favorable but negative predictive values are low. Consequently, MRE and CTE can be relied upon, if a positive result is obtained whereas a negative enterography should be interpreted with caution.
对于有症状的克罗恩病（CD）患者，了解小肠疾病活动和狭窄情况的有效信息具有重要临床意义。此类信息有助于做出药物或手术治疗决策，可通过磁共振小肠造影（MRE）或计算机断层扫描小肠造影（CTE）获得。
本前瞻性双盲研究纳入了50例有症状的已患CD且需要小肠成像以辅助治疗策略调整的患者。MRE和CTE在同一天交替进行，随后与金标准进行比较：预定的回肠镜检查病变（n = 30）或有（n = 12）或无（n = 3）术中肠镜检查的手术结果。
共有35例患者存在活动性小肠CD（空肠0例，回肠1例，（新）末端回肠34例），20例有小肠狭窄。MRE检测小肠CD的敏感性和特异性分别为74%和80%，而CTE分别为83%和70%（p≥0.5）。MRE和CTE检测小肠狭窄的敏感性分别为55%和70%（p = 0.3），特异性为92%。
MRE和CTE在检测小肠CD和狭窄方面具有相当的诊断准确性。在有症状的CD患者且疾病患病率较高时，阳性预测值较好，但阴性预测值较低。因此，如果获得阳性结果，可以信赖MRE和CTE，而阴性小肠造影结果的解读应谨慎。
