Pous-Serrano S, Frasson M, Palasí Giménez R, Sanchez-Jordá G, Pamies-Guilabert J, Llavador Ros M, Nos Mateu P, Garcia-Granero E
Department of General Surgery, Colorectal Unit, La Fe University Hospital, Valencia, Spain.
Department of Radiology, La Fe University Hospital, Valencia, Spain.
Colorectal Dis. 2017 May;19(5):O126-O133. doi: 10.1111/codi.13613.
To assess the accuracy of magnetic resonance enterography in predicting the extension, location and characteristics of the small bowel segments affected by Crohn's disease.
This is a prospective study including a consecutive series of 38 patients with Crohn's disease of the small bowel who underwent surgery at a specialized colorectal unit of a tertiary hospital. Preoperative magnetic resonance enterography was performed in all patients, following a homogeneous protocol, within the 3 months prior to surgery. A thorough exploration of the small bowel was performed during the surgical procedure; calibration spheres were used according to the discretion of the surgeon. The accuracy of magnetic resonance enterography in detecting areas affected by Crohn's disease in the small bowel was assessed. The findings of magnetic resonance enterography were compared with surgical and pathological findings.
Thirty-eight patients with 81 lesions were included in the study. During surgery, 12 lesions (14.8%) that were not described on magnetic resonance enterography were found. Seven of these were detected exclusively by the use of calibration spheres, passing unnoticed at surgical exploration. Magnetic resonance enterography had 90% accuracy in detecting the location of the stenosis (75.0% sensitivity, 95.7% specificity). Magnetic resonance enterography did not precisely diagnose the presence of an inflammatory phlegmon (accuracy 46.2%), but it was more accurate in detecting abscesses or fistulas (accuracy 89.9% and 98.6%, respectively).
Magnetic resonance enterography is a useful tool in the preoperative assessment of patients with Crohn's disease. However, a thorough intra-operative exploration of the entire small bowel is still necessary.
评估磁共振小肠造影术在预测克罗恩病累及的小肠节段的范围、位置及特征方面的准确性。
这是一项前瞻性研究，纳入了在一家三级医院的专业结直肠科接受手术的38例小肠克罗恩病患者。所有患者在术前3个月内按照统一方案进行了术前磁共振小肠造影。手术过程中对小肠进行了全面探查；外科医生根据需要使用了校准球。评估磁共振小肠造影术检测小肠克罗恩病受累区域的准确性。将磁共振小肠造影的结果与手术及病理结果进行比较。
本研究纳入了38例患者，共81处病变。手术中发现12处病变（14.8%）在磁共振小肠造影中未被描述。其中7处病变是仅通过使用校准球才被发现的，在手术探查时被忽略。磁共振小肠造影术检测狭窄部位的准确性为90%（敏感性75.0%，特异性95.7%）。磁共振小肠造影术不能准确诊断炎性肿块的存在（准确性46.2%），但在检测脓肿或瘘管方面更准确（准确性分别为89.9%和98.6%）。
磁共振小肠造影术是克罗恩病患者术前评估的有用工具。然而，术中对整个小肠进行全面探查仍然是必要的。
