计算机断层扫描灌肠造影和磁共振成像在诊断大肠子宫内膜异位症患者多灶性和多中心性肠病变中的作用
Contribution of Computed Tomography Enema and Magnetic Resonance Imaging to Diagnose Multifocal and Multicentric Bowel Lesions in Patients With Colorectal Endometriosis.
作者信息
Belghiti Jeremie, Thomassin-Naggara Isabelle, Zacharopoulou Chrysoula, Zilberman Sonia, Jarboui Lamia, Bazot Marc, Ballester Marcos, Daraï Emile
机构信息
Department of Obstetrics and Gynecology, Tenon Hospital, AP-HP, Paris, France; GRC6-UPMC: Centre expert en Endométriose (C3E), Paris, France.
Department of Radiology, Tenon Hospital, AP-HP, Paris, France; GRC6-UPMC: Centre expert en Endométriose (C3E), Paris, France; UMR_S938 Université Pierre et Marie Curie Paris 6, Paris, France.
出版信息
J Minim Invasive Gynecol. 2015 Jul-Aug;22(5):776-84. doi: 10.1016/j.jmig.2015.02.019. Epub 2015 Mar 7.
STUDY OBJECTIVE
To evaluate the diagnostic contribution of the computed tomography (CT) enema and magnetic resonance imaging (MRI) for multifocal (multiple lesions affecting the same segment) and multicentric (multiple lesions affecting several digestive segments) bowel endometriosis.
DESIGN
Prospective cohort study (Canadian Task Force classification II-2).
PATIENTS
Eighty-five patients.
SETTING
Tenon University Hospital, Paris, France.
INTERVENTION
All patients received a preoperative CT enema and underwent MRI interpreted by 2 radiologists.
MEASUREMENTS AND MAIN RESULTS
Patients underwent colorectal resection for colorectal endometriosis from February 2009 to November 2012. Nineteen patients (22%) had multifocal lesions, and 11 patients (13%) had multicentric lesions. Six patients (7%) had both multifocal and multicentric lesions. The sensitivity, specificity, and positive and negative likelihood ratios (LRs) of MRI for the diagnosis of multifocal lesions were 0.58, 0.84, 3.55, and 0.5, respectively. The sensitivity, specificity, and positive and negative LRs of the CT enema for the diagnosis of multifocal lesions were 0.64, 0.86, 4.56, and 0.4, respectively. The sensitivity, specificity, and positive LR of MRI for the diagnosis of multicentric lesions were 1, 0.88, and 8.4, respectively. The sensitivity, specificity, and positive and negative LRs of MRI for the diagnosis of multicentric lesions were 0.46, 0.92, 5.6, and 0.59, respectively. No difference was observed between MRI and the CT enema for the diagnosis of multifocal and multicentric colorectal endometriosis. The interobserver agreement was good for MRI and the CT enema (κ = 0.45 and 0.45) for multifocality, and it was poor for both MRI and the CT enema (κ = 0.32 and 0.34) for multicentricity.
CONCLUSIONS
Both MRI and the CT enema were able to diagnose multifocal and multicentric bowel endometriosis with similar accuracy.
研究目的
评估计算机断层扫描（CT）灌肠和磁共振成像（MRI）对多灶性（影响同一肠段的多个病变）和多中心性（影响多个消化段的多个病变）肠子宫内膜异位症的诊断价值。
设计
前瞻性队列研究（加拿大工作组分类II-2）。
患者
85例患者。
地点
法国巴黎Tenon大学医院。
干预措施
所有患者均接受术前CT灌肠，并由2名放射科医生对MRI进行解读。
测量指标及主要结果
2009年2月至2012年11月，患者因结肠直肠子宫内膜异位症接受了结直肠切除术。19例患者（22%）有多发灶性病变，11例患者（13%）有多中心性病变。6例患者（7%）既有多发灶性病变又有多中心性病变。MRI诊断多发灶性病变的敏感性、特异性、阳性似然比和阴性似然比分别为0.58、0.84、3.55和0.5。CT灌肠诊断多发灶性病变的敏感性、特异性、阳性似然比和阴性似然比分别为0.64、0.86、4.56和0.4。MRI诊断多中心性病变的敏感性、特异性和阳性似然比分别为1、0.88和8.4。CT灌肠诊断多中心性病变的敏感性、特异性、阳性似然比和阴性似然比分别为0.46、0.92、5.6和0.59。在诊断多灶性和多中心性结肠直肠子宫内膜异位症方面，未观察到MRI与CT灌肠之间存在差异。观察者间一致性在MRI和CT灌肠诊断多发灶性病变方面良好（κ=0.45和0.45），而在诊断多中心性病变方面，MRI和CT灌肠均较差（κ=0.32和0.34）。
结论
MRI和CT灌肠在诊断多灶性和多中心性肠子宫内膜异位症方面准确性相似。
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