Klang E, Kopylov U, Eliakim R, Rozendorn N, Yablecovitch D, Lahat A, Ben-Horin S, Amitai M M
Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel; Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel.
Department of Gastroenterology, The Chaim Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
Clin Radiol. 2017 Sep;72(9):798.e7-798.e13. doi: 10.1016/j.crad.2017.04.006. Epub 2017 May 13.
To investigate the role of restricted diffusion in quiescent Crohn's disease (CD) patients and its association with inflammatory biomarkers and endoscopic disease.
Fifty-two quiescent CD patients prospectively underwent magnetic resonance enterography (MRE) and video capsule endoscopy (VCE) and were tested for the inflammatory biomarkers, faecal calprotectin (FCP) and C-reactive protein (CRP). Restricted diffusion in the distal ileum was qualitatively (absence/presence) and quantitatively (apparent diffusion coefficient [ADC]) assessed by two readers. The VCE-based Lewis score was calculated for the distal ileum. Restricted diffusion sensitivity and specificity for VCE ulcerations were assessed for patients with elevated (>100 μg/g) or normal (<100 μg/g) FCP. Receiver operating characteristic (ROC) curve was used to assess the ability of ADC to identify patients with concurrent VCE ulceration and elevated FCP.
The sensitivity and specificity of restricted diffusion for patients with VCE ulceration were higher in patients with elevated FCP (reader 1: 71.4%, 80%, reader 2: 76.2%, 100%, respectively) compared to patients with normal FCP (reader 1: 46.2%, 61.5%; reader 2: 15.4%, 76.9%, respectively). The ADC had a high diagnostic accuracy for identifying patients that had concurrent VCE ulceration and elevated FCP (reader 1: AUC=0.819, reader 2: AUC=0.832).
In quiescent CD patients, the presence of restricted diffusion is suggestive of an active inflammation, associated with elevated FCP. Thus, DWI may serve as a clinical tool in the follow-up of these patients, implying subclinical inflammatory flares.
探讨受限扩散在静止期克罗恩病（CD）患者中的作用及其与炎症生物标志物和内镜下疾病的关联。
52例静止期CD患者前瞻性接受磁共振小肠造影（MRE）和视频胶囊内镜检查（VCE），并检测炎症生物标志物粪便钙卫蛋白（FCP）和C反应蛋白（CRP）。由两名阅片者对回肠末端的受限扩散进行定性（有无）和定量（表观扩散系数[ADC]）评估。计算基于VCE的回肠末端Lewis评分。对FCP升高（>100μg/g）或正常（<100μg/g）的患者评估受限扩散对VCE溃疡的敏感性和特异性。采用受试者工作特征（ROC）曲线评估ADC识别并发VCE溃疡且FCP升高患者的能力。
与FCP正常的患者相比，FCP升高的患者中受限扩散对VCE溃疡患者的敏感性和特异性更高（阅片者1分别为71.4%、80%，阅片者2分别为76.2%、100%）（阅片者1分别为46.2%、61.5%；阅片者2分别为15.4%、76.9%）。ADC对识别并发VCE溃疡且FCP升高的患者具有较高的诊断准确性（阅片者1：AUC = 0.819，阅片者2：AUC = 0.832）。
在静止期CD患者中，受限扩散的存在提示存在与FCP升高相关的活动性炎症。因此，扩散加权成像（DWI）可作为这些患者随访中的一种临床工具，提示亚临床炎症发作。
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