Department of Gastroenterology, Hospital Clínic de Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
Gut. 2013 Nov;62(11):1566-72. doi: 10.1136/gutjnl-2012-303240. Epub 2012 Aug 30.
The aim of this study was to determine the diagnostic accuracy of magnetic resonance colonography (MRC) for the evaluation of disease activity and severity in patients with ulcerative colitis (UC) using endoscopy as the reference standard.
Fifty patients with UC underwent colonoscopy and MRC for the evaluation of disease activity. All patients were prospectively and consecutively included. Endoscopic activity was evaluated globally and on a segment basis using the modified Baron score (MBS), and also classified as absent, mild to moderate (inflammation without ulcers) or severe (presence of ulceration). MRC parameters evaluated in each segment were: wall thickness, pre- and post-contrast wall signal intensity, relative contrast enhancement (RCE), mural oedema, ulcers, enlarged lymph nodes and the comb sign.
Independent predictors for endoscopic activity on a segment basis were RCE (p=0.006), presence of oedema (p=0.003), enlarged lymph nodes (p<0.001) and the comb sign (p<0.001). A segmental simplified MRC index (MRC-S) ≥ 1 detected endoscopic inflammation with high diagnostic accuracy (sensitivity 87%, specificity 88%, area under the curve (AUC) 0.95; p<0.001). MRC-S index ≥ 2 detected severe lesions with high sensitivity (83%) and specificity (82%) with an AUC of 0.91 (p<0.001). The MRC-S index strongly correlated with the MBS (r=0.81, p<0.001) and with the subjective assessment of the radiologists for the evaluation of disease severity (r=0.77, p<0.001).
MRC has a high accuracy for the diagnosis of disease activity and severity in UC.
本研究旨在通过以结肠镜检查为参考标准，确定磁共振结肠成像（MRC）在评估溃疡性结肠炎（UC）患者疾病活动度和严重程度方面的诊断准确性。
50 例 UC 患者接受结肠镜检查和 MRC 检查以评估疾病活动度。所有患者均前瞻性连续纳入。使用改良 Baron 评分（MBS）对内镜活动度进行整体和分段评估，并分为无、轻度至中度（无溃疡炎症）或重度（存在溃疡）。对每段 MRC 评估的参数包括：壁厚度、对比前后壁信号强度、相对对比增强（RCE）、壁水肿、溃疡、增大的淋巴结和梳状征。
在分段基础上，内镜活动的独立预测因素是 RCE（p=0.006）、水肿存在（p=0.003）、增大的淋巴结（p<0.001）和梳状征（p<0.001）。节段性简化 MRC 指数（MRC-S）≥1 可检测出具有高诊断准确性的内镜炎症（敏感性 87%，特异性 88%，曲线下面积（AUC）0.95；p<0.001）。MRC-S 指数≥2 检测到严重病变，具有高敏感性（83%）和特异性（82%），AUC 为 0.91（p<0.001）。MRC-S 指数与 MBS 呈强相关（r=0.81，p<0.001），与放射科医生对疾病严重程度评估的主观评估呈强相关（r=0.77，p<0.001）。
MRC 对 UC 的疾病活动度和严重程度具有很高的准确性。
