Wiarda Bart M, Mensink Peter B F, Heine Dimitri G N, Stolk Mark, Dees Jan, Hazenberg Hugo, Stoker Jaap, van der Woude C Janneke, Kuipers Ernst J
Department of Radiology, Medical Center Alkmaar, The Netherlands.
Abdom Imaging. 2012 Jun;37(3):397-403. doi: 10.1007/s00261-011-9816-8.
New modalities are available to visualize the small bowel in patients with Crohn's disease (CD). The aim of this study was to compare the diagnostic yield of magnetic resonance enteroclysis (MRE) and capsule endoscopy (CE) to balloon-assisted enteroscopy (BAE) in patients with suspected or established CD of the small bowel. Consecutive, consenting patients first underwent MRE followed by CE and BAE. Patients with high-grade stenosis at MRE did not undergo CE. Reference standard for small bowel CD activity was a combination of BAE and an expert panel consensus diagnosis. Analysis included 38 patients, 27 (71%) females, mean age 36 (20-74) years, with suspected (n = 20) or established (n = 18) small bowel CD: 16 (42%) were diagnosed with active CD, and 13 (34%) by MRE with suspected high-grade stenosis, who consequently did not undergo CE. The reference standard defined high-grade stenosis in 10 (26%) patients. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of MRE and CE for small bowel CD activity were 73 and 57%, 90 and 89%, 88 and 67%, and 78 and 84%, respectively. CE was complicated by capsule retention in one patient. MRE has a higher sensitivity and PPV than CE in small bowel CD. The use of CE is considerably limited by the high prevalence of stenotic lesions in these patients.
目前有多种新方法可用于可视化克罗恩病（CD）患者的小肠。本研究旨在比较磁共振小肠造影（MRE）、胶囊内镜（CE）与气囊辅助小肠镜检查（BAE）对疑似或确诊小肠CD患者的诊断效能。连续纳入的自愿参与患者首先接受MRE检查，随后接受CE和BAE检查。MRE显示存在高度狭窄的患者不接受CE检查。小肠CD活动度的参考标准是BAE检查结果与专家小组的共识诊断相结合。分析纳入了38例患者，其中27例（71%）为女性，平均年龄36岁（20 - 74岁），患有疑似（n = 20）或确诊（n = 18）的小肠CD：16例（42%）被诊断为活动性CD，13例（34%）经MRE检查怀疑存在高度狭窄，因此未接受CE检查。参考标准确定10例（26%）患者存在高度狭窄。MRE和CE对小肠CD活动度的敏感性、特异性、阳性预测值（PPV）和阴性预测值分别为73%和57%、90%和89%、88%和67%、78%和84%。1例患者发生CE胶囊滞留并发症。在小肠CD中，MRE的敏感性和PPV高于CE。由于这些患者中狭窄病变的高发生率，CE的应用受到很大限制。
