Horjus Talabur Horje C S, Bruijnen R, Roovers L, Groenen M J M, Joosten F B M, Wahab P J
Department of Gastroenterology, Rijnstate Hospital, Arnhem, the Netherlands.
Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands.
PLoS One. 2015 Aug 31;10(8):e0136105. doi: 10.1371/journal.pone.0136105. eCollection 2015.
To prospectively examine the feasibility and accuracy of Contrast Enhanced Ultrasound (CEUS) in the assessment of Crohn's disease (CD) activity in the terminal ileum in comparison to Magnetic Resonance Enterography (MRE), using endoscopy as a reference standard.
105 consecutive patients with alleged clinically active CD were assessed by MRE and CEUS. CEUS of the terminal ileum was performed using an intravenous microbubble contrast enhancer. Accuracy values of CEUS and MRE for the presence of active terminal ileitis were evaluated using the Receiver Operating Characteristic method, using endoscopic findings as a reference standard. Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.
CEUS was feasible in 98% of patients, MRE in all. Optimal diagnostic accuracy in CEUS was obtained at a peak intensity value of 10%, showing 100% sensitivity, 92% specificity and an accuracy of 99% in demonstrating ileal mucosal inflammation. For MRE, overall sensitivity, specificity and accuracy were, 87%, 100%, and 88%, respectively. CEUS and MRE were highly correlated in assessing length and wall thickness of the terminal ileum. CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.
The accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.
以前瞻性方式，以内镜检查作为参考标准，对比磁共振肠造影（MRE），研究对比增强超声（CEUS）评估回肠末端克罗恩病（CD）活动度的可行性与准确性。
105例临床疑似活动期CD患者接受了MRE和CEUS检查。采用静脉注射微泡造影剂对回肠末端进行CEUS检查。以内镜检查结果作为参考标准，采用受试者操作特征法评估CEUS和MRE对活动性回肠末端炎的诊断准确性。通过McNemar检验比较MRE和CEUS的敏感性和特异性值。
98%的患者可行CEUS检查，所有患者均可行MRE检查。CEUS在峰值强度值为10%时获得最佳诊断准确性，在显示回肠黏膜炎症方面，敏感性为100%，特异性为92%，准确性为99%。对于MRE，总体敏感性、特异性和准确性分别为87%、100%和88%。CEUS和MRE在评估回肠末端长度和肠壁厚度方面高度相关。CEUS识别出了MRE检测到的16处狭窄中的11处，但未发现瘘管。
在评估活动性、非复杂性回肠末端CD方面，CEUS的准确性与MRE相当，因此在这些患者的随访中是一种有价值的床边替代MRE的检查方法。
