磁共振肠道成像能否筛查小儿炎症性肠病的肛周疾病？
Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?
机构信息
Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada.
Department of Medical Imaging, University of Toronto, Toronto, Canada.
出版信息
J Magn Reson Imaging. 2018 Jun;47(6):1638-1645. doi: 10.1002/jmri.25888. Epub 2017 Nov 14.
BACKGROUND
Pediatric Crohn's disease is associated with perianal disease (PAD). Magnetic resonance enterography (MRE) assesses small bowel involvement in pediatric inflammatory bowel disease (PIBD). Pelvic MRI (P-MRI) is the gold standard for assessing PAD.
PURPOSE
To determine if MRE can accurately detect PAD in PIBD, distinguishing perianal fistulae (PAF) from perianal abscesses (PAA), referenced against P-MRI.
STUDY TYPE
Retrospective.
POPULATION
Seventy-seven PIBD patients, 27 females (mean age 14.1 years), with P-MRI and MRE within 6 months.
FIELD STRENGTH/SEQUENCE: 1.5T and 3T; P-MRI: sagittal fat suppressed (FS) T fast spin-echo (FSE), coronal short tau inversion recovery, axial T FSE, coronal and axial postcontrast FS T FSE; MRE: coronal balanced steady-state free-precession (SSFP), coronal cine SSFP, coronal and axial single-shot T FS, axial SSFP, coronal ultrafast 3D T -weighted gradient echo FS (3D T GE), axial diffusion-weighted imaging, coronal and axial postcontrast 3D T GE FS.
ASSESSMENT
Two radiologists independently, then by consensus, assessed randomized MRI exams, recording PAF number, location, and length; and PAA number, location, length, and volume. Sensitivity analysis used clinical disease as the gold standard, calculated separately for P-MRI and MRE.
STATISTICAL TESTS
Comparing MRE and P-MRI consensus data, sensitivity, specificity, positive, and negative predictive values (P/NPV) were calculated. Inter- and intrareader reliability were assessed using kappa statistics.
RESULTS
P-MRI and MRE were paired, detecting PAD in 73 patients, PAF in 63, and PAA in 31 P-MRI. MRE sensitivities, specificities, PPV, and NPV were: PAD 82%, 100%, 100%, 23%; PAF 74%, 71%, 92%, 38%; PAA 51%, 85%, 69%, 72%; clinical 82%, 22%, 37%, 69%; clinical P-MRI 96%, 8%, 37%, 80%. MRE interreader agreement for PAD was moderate (kappa = 0.51 [0.29-0.73]), fair for PAF and PAA.
DATA CONCLUSION
Using a standard technique, MRE can detect PAD with high specificity and moderate sensitivity in PIBD, missing some PAF and small PAA.
LEVEL OF EVIDENCE
3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1638-1645.
背景
小儿克罗恩病与肛周疾病（PAD）有关。磁共振肠造影术（MRE）评估小儿炎症性肠病（PIBD）的小肠受累情况。盆腔 MRI（P-MRI）是评估 PAD 的金标准。
目的
确定 MRE 是否可以准确检测 PIBD 中的 PAD，将肛周瘘（PAF）与肛周脓肿（PAA）区分开来，并与 P-MRI 进行对照。
研究类型
回顾性。
人群
77 名 PIBD 患者，27 名女性（平均年龄 14.1 岁），在 6 个月内接受了 P-MRI 和 MRE 检查。
磁场强度/序列：1.5T 和 3T；P-MRI：矢状位脂肪抑制（FS）T 快速自旋回波（FSE）、冠状位短 tau 反转恢复、轴向 T FSE、冠状位和轴向对比 FS T FSE；MRE：冠状位平衡稳态自由进动（SSFP）、冠状位电影 SSFP、冠状位和轴向单次激发 T FS、轴向 SSFP、冠状位超快 3D T-加权梯度回波 FS（3D T GE）、轴向扩散加权成像、冠状位和轴向对比 3D T GE FS。
评估
两位放射科医生独立评估随机 MRI 检查，记录 PAF 的数量、位置和长度；以及 PAA 的数量、位置、长度和体积。使用临床疾病作为金标准进行了敏感性分析，分别对 P-MRI 和 MRE 进行了计算。
统计学检验
比较 MRE 和 P-MRI 共识数据，计算敏感性、特异性、阳性和阴性预测值（P/NPV）。使用kappa 统计评估了读者间和读者内的可靠性。
结果
MRE 和 P-MRI 配对，在 73 名患者中检测到 PAD，在 63 名患者中检测到 PAF，在 31 名 P-MRI 患者中检测到 PAA。MRE 的敏感性、特异性、PPV 和 NPV 分别为：PAD 82%、100%、100%、23%；PAF 74%、71%、92%、38%；PAA 51%、85%、69%、72%；临床 82%、22%、37%、69%；临床 P-MRI 96%、8%、37%、80%。MRE 对 PAD 的读者间一致性为中度（kappa=0.51[0.29-0.73]），对 PAF 和 PAA 的一致性为一般。
数据结论
使用标准技术，MRE 可以在 PIBD 中以高特异性和中等敏感性检测 PAD，会遗漏一些 PAF 和小的 PAA。
证据水平
3 技术功效：阶段 2 J. Magn. Reson. Imaging 2018;47:1638-1645.
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