Department of Surgery and Transplantation, Chaim Sheba Medical Center Ramat Gan Israel, Israel.
J Crohns Colitis. 2013 Jul;7(6):490-6. doi: 10.1016/j.crohns.2012.07.024. Epub 2012 Aug 21.
Both 2-dimensional and 3-dimensional endoanal ultrasounds have been shown to be accurate in the definition of the anatomy of complex fistulae-in-ano in patients with perianal Crohn's disease. Recently, a Crohn's Ultrasound Fistula Sign (CUFS) has been suggested as a discriminating feature of perianal Crohn's disease as has the presence of fistulous debris and fistular bifurcation. We blindly assessed 197 patients (39 Crohn's fistulae and 158 cryptogenic fistulae) to determine if these signs differentiated fistula types. The incidence of CUFS in Crohn's cases was 17/39 (43.6%) and in cryptogenic cases was 4/158 (2.5%) (P<0.0001). The sensitivity, specificity, positive and negative predictive values and accuracy for CUFS were 43.6%, 97.5%, 80.9%, 87.5% and 86.8%, respectively. The presence of debris and fistula bifurcation in evaluable cases had a high specificity (87.2% and 81.8%, respectively) but poor sensitivity. The kappa values for or against CUFS, debris and bifurcation in Crohn's cases between 2 observers blinded to the diagnosis were 0.85, 0.72 and 0.93, respectively and in cryptogenic fistulae were 0.89, 0.85 and 0.80, respectively. The kappa values of an agreed consensus for CUFS in Crohn's disease, cryptogenic fistulae and overall with a third observer with no ultrasound experience were 0.62, 0.85 and 0.77, respectively. The presence of CUFS differentiates Crohn's-related from cryptogenic fistulae-in-ano with a high level of agreement for this sign between experienced and inexperienced observers blinded to the underlying diagnosis.
二维和三维内超声均已被证明可准确定义患有肛周克罗恩病的复杂肛痿患者的解剖结构。最近，有人提出了一种克罗恩超声肛瘘征象（CUFS），作为肛周克罗恩病的鉴别特征，此外还有瘘管碎片和瘘管分叉的存在。我们对 197 例患者（39 例克罗恩肛瘘和 158 例隐匿性肛瘘）进行了盲法评估，以确定这些征象是否能区分肛瘘类型。在克罗恩病例中，CUFS 的发生率为 17/39（43.6%），在隐匿性病例中为 4/158（2.5%）（P<0.0001）。CUFS 的灵敏度、特异性、阳性预测值、阴性预测值和准确率分别为 43.6%、97.5%、80.9%、87.5%和 86.8%。在可评估的病例中，碎片和瘘管分叉的存在具有很高的特异性（分别为 87.2%和 81.8%），但灵敏度较低。两位观察者对克罗恩病病例中 CUFS、碎片和分叉的诊断进行盲法评估，两者之间的kappa 值分别为 0.85、0.72 和 0.93，在隐匿性肛瘘中分别为 0.89、0.85 和 0.80。第三位无超声经验的观察者对克罗恩病、隐匿性肛瘘和整体病例中 CUFS 的一致性共识的kappa 值分别为 0.62、0.85 和 0.77。CUFS 的存在可区分克罗恩相关和隐匿性肛痿，具有经验丰富和无经验观察者对该征象的高度一致性。
