Department of Medicine, University of California San Diego, La Jolla, CA, USA,
Dig Dis Sci. 2014 Apr;59(4):838-49. doi: 10.1007/s10620-013-2964-7. Epub 2013 Dec 10.
Computed tomography (CT) and magnetic resonance (MR) enterography are now widely used to diagnose and monitor Crohn's disease.
We sought to assess the use of enterography for management of inflammatory bowel disease (IBD) in our medical center.
We performed a retrospective review of all patients diagnosed with IBD who underwent MR or CT enterography from November 1, 2010 to October 25, 2012 at our institution. We assessed disease complications identified by enterography, agreement between disease activity determined by endoscopy and enterography, association between inflammatory markers and enterography-determined disease activity and recommended changes in medical and surgical management following enterography.
A total of 311 enterography studies (291 MR and 20 CT enterographies) were performed on 270 patients, including 258 (83.0 %) on patients with presumed Crohn's disease and 53 (17.0 %) with presumed ulcerative colitis. Active small bowel (SB) disease was noted in 73/311 (23.5 %) studies. Complications including strictures, perianal fistulas, abscesses and SB fistulas were noted in 108/311 (34.7 %) studies. Endoscopic and enterography defined active disease had an agreement of κ = 0.36 in the ileum (n = 179). A total of 142/311 (45.7 %) enterographies were associated with recommended medication changes within 90 days while surgery or endoscopic dilation of stricture was recommended following 41/311 (13.2 %) enterographies. Enterography resulted in a change in diagnosis from ulcerative colitis to Crohn's in 5/311 (1.6 %) studies.
Enterography reveals active disease and complications not evident on endoscopy and should be considered in the initial diagnosis, assessment of disease activity, and monitoring of therapy in patients with IBD.
计算机断层扫描（CT）和磁共振（MR）肠造影术现在广泛用于诊断和监测克罗恩病。
我们旨在评估我们医疗中心使用肠造影术来管理炎症性肠病（IBD）。
我们对 2010 年 11 月 1 日至 2012 年 10 月 25 日期间在我院接受 MR 或 CT 肠造影术的所有诊断为 IBD 的患者进行了回顾性研究。我们评估了肠造影术发现的疾病并发症、内镜和肠造影术确定的疾病活动之间的一致性、炎症标志物与肠造影术确定的疾病活动之间的关系以及肠造影术建议的医疗和手术管理变化。
对 270 例患者进行了 311 次肠造影术检查（291 次 MR 和 20 次 CT 肠造影术），其中 258 例（83.0%）患者疑似患有克罗恩病，53 例（17.0%）患者疑似患有溃疡性结肠炎。73/311（23.5%）研究发现有活动性小肠（SB）疾病。108/311（34.7%）研究发现有并发症，包括狭窄、肛周瘘管、脓肿和 SB 瘘管。内镜和肠造影术在回肠（n=179）中确定活动期疾病的一致性为κ=0.36。311 次肠造影术中有 142 次（45.7%）在 90 天内建议药物变化，41 次（13.2%）建议手术或内镜扩张狭窄。5/311（1.6%）的肠造影术改变了溃疡性结肠炎的诊断为克罗恩病。
肠造影术揭示了内镜检查不明显的活动期疾病和并发症，应考虑用于 IBD 的初始诊断、疾病活动评估和治疗监测。
