Department of Diagnostic Imaging, Warren Alpert School of Medicine, 593 Eddy St., Providence, RI 02903, United States.
Eur J Radiol. 2012 May;81(5):e763-9. doi: 10.1016/j.ejrad.2012.02.011. Epub 2012 Mar 23.
To evaluate the efficacy of MR enterography (MRE) in patients with known or suspected Crohn's disease without the use of anti-peristaltic pharmacologic agents compared to colonoscopy and histology.
A retrospective review of 850 consecutive patients who underwent routine MRE to evaluate known or suspected Crohn's disease was performed. Of these, 310 patients also underwent colonoscopy with biopsy(s) within 90 days. The results of the MRE were compared to the colonoscopy and pathology reports to determine the presence or absence of disease in evaluable bowel segments. Individual imaging parameters (including wall thickening, enhancement, T2 signal, mesenteric vascular prominence and adenopathy) were also separately analyzed to determine their independent predictive value.
In 310 patients, the overall sensitivity and specificity of MRE (using endoscopy as a gold standard) were 85% and 80% respectively (kappa=0.65). The sensitivity of MRE for detection of pathologically severe disease was 87% in the terminal ileum (TI) and 88% in the colon. In the subset of 162 patients who underwent colonoscopy within 30 days of MRE, the overall sensitivity remained 85% but the specificity increased to 85% (kappa=0.69). Wall thickening and abnormal enhancement were sensitive indicators of Crohn's disease (75% and 78%), while abnormal T2 signal, mesenteric vascular prominence and adenopathy were specific (86%, 91% and 93%).
MRE compares favorably to colonoscopy for evaluation of known or suspected Crohn's disease noninvasively and without the exposure to ionizing radiation associated with CT enterography (CTE).
本研究旨在评估对比结肠镜检查和组织学检查，磁共振肠造影术（MRE）在已知或疑似克罗恩病患者中的应用价值，且无需使用抗蠕动药物。
对 850 例连续接受常规 MRE 检查以评估已知或疑似克罗恩病的患者进行回顾性分析，其中 310 例患者在 90 天内接受结肠镜检查和活检。将 MRE 结果与结肠镜和病理报告进行比较，以确定可评估肠段是否存在疾病。单独分析了各个影像学参数（包括肠壁增厚、强化、T2 信号、肠系膜血管突出和淋巴结病），以确定其独立预测价值。
在 310 例患者中，MRE 的总体敏感性和特异性（以结肠镜检查为金标准）分别为 85%和 80%（kappa 值=0.65）。MRE 对末端回肠（TI）和结肠病理严重疾病的检测敏感性分别为 87%和 88%。在 162 例 MRE 检查后 30 天内接受结肠镜检查的患者亚组中，总体敏感性仍为 85%，但特异性提高至 85%（kappa 值=0.69）。肠壁增厚和异常强化是克罗恩病的敏感指标（敏感性分别为 75%和 78%），而异常 T2 信号、肠系膜血管突出和淋巴结病具有特异性（特异性分别为 86%、91%和 93%）。
MRE 与结肠镜检查相比，在不使用与 CT 肠造影术（CTE）相关的电离辐射的情况下，可更有效地非侵入性评估已知或疑似克罗恩病。
