Schleder S, Pawlik M, Wiggermann P, Ott C, Fichtner-Feigl S, Müller-Wille R, Stroszczynski C, Schreyer A G
Department of Radiology, University Hospital Regensburg, Germany.
Rofo. 2013 Sep;184(10):992-7. doi: 10.1055/s-0033-1335445. Epub 2013 Jul 26.
To evaluate the extent to which MRE can be used as an observer-independent, objective imaging method for the diagnosis and evaluation of CD with respect to the detection of inflammatory changes of the small bowel and lymphadenopathy as diagnostic criterion and bowel distension as a quality criterion.
MRE scans of 84 patients (42 female, median age 37 years) were evaluated independently by 4 experienced radiologists. Analysis of inflammatory changes of the bowel wall, lymphadenopathy and adequate bowel distension was conducted separately for the jejunum, ileum and terminal ileum. The Kendall's W-test was used for the statistical comparison of concordance.
In a total of 55 patients, inflammatory activity of the bowel wall was detected and MRE was found to have a high interobserver reproducibility concerning inflammatory changes of the intestinal wall (Kendall's W 0.527 - 0.823). Concerning lymphadenopathy (31 cases, 36.9 %), a low to moderate consensus could be shown with a Kendall's W value of 0.402 - 0.505. For the assessment of adequate bowel distension, a moderate concordance between the operators could be found (Kendall's W 0.497 - 0.581).
MRE has proven high interobserver agreement with respect to the diagnosis of inflammatory disease activity of the bowel as a diagnostic criterion in patients with CD. Concerning adequate bowel distension as a quality criterion of the examination itself and lymphadenopathy as a diagnostic criterion, moderate interobserver agreement could be found. This is thought to have a rather small effect on the diagnostic significance and conclusiveness of the method in the daily routine.
▶ MR enterography as observer independent diagnostic procedure in patients with Chron's Disease. ▶ Highest interobserver concordance for the criterion of inflammatory bowel wall affection. ▶ Moderate interobserver concordance for lymphadenopathy and bowel distension.
评估磁共振弹性成像（MRE）在以小肠炎症改变和淋巴结病作为诊断标准、肠扩张作为质量标准的情况下，作为一种独立于观察者的客观成像方法用于克罗恩病（CD）诊断和评估的程度。
84例患者（42例女性，中位年龄37岁）的MRE扫描由4名经验丰富的放射科医生独立评估。对空肠、回肠和回肠末端的肠壁炎症改变、淋巴结病和充分的肠扩张分别进行分析。采用肯德尔W检验进行一致性的统计学比较。
总共55例患者检测到肠壁炎症活动，发现MRE在肠壁炎症改变方面具有较高的观察者间再现性（肯德尔W值为0.527 - 0.823）。对于淋巴结病（31例，36.9%），肯德尔W值为0.402 - 0.505，显示出低至中度的一致性。对于充分肠扩张的评估，操作者之间可发现中度一致性（肯德尔W值为0.497 - 0.581）。
MRE已被证明在诊断CD患者的肠道炎症疾病活动方面具有较高的观察者间一致性。对于作为检查本身质量标准的充分肠扩张和作为诊断标准的淋巴结病，可发现中度的观察者间一致性。这被认为在日常实践中对该方法的诊断意义和结论性影响较小。
▶ 磁共振小肠造影作为克罗恩病患者独立于观察者的诊断程序。▶ 肠壁炎症标准的观察者间一致性最高。▶ 淋巴结病和肠扩张的观察者间一致性中等。
