Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
J Crohns Colitis. 2018 Feb 28;12(3):313-320. doi: 10.1093/ecco-jcc/jjx156.
Capsule endoscopy [CE] and magnetic resonance enterography [MRE] are prime modalities for evaluation of the small bowel in Crohn's disease [CD]. Detection of proximal small bowel [SB] inflammation in CD by MRE is challenging. Currently available quantitative MRE scores do not incorporate proximal SB data. The MRE global score [MEGS] was designed for quantitative evaluation of the entire digestive tract; its accuracy in the proximal SB has not previously been evaluated. This study compared the evaluation of the small bowel inflammation by MEGS and CE-derived quantitative score (the Lewis score[LS]).
CD patients in stable clinical remission were prospectively recruited and underwent MRE and CE; faecal calprotectin [FC] levels were obtained. MEGS was calculated for each SB segment and the entire SB [SBMEGS]. SB inflammation on CE was quantified using LS. A cumulative Lewis score [C-LS] was calculated based on summation of three tertiles scores.
Fifty patients were included. There was a significant correlation of SBMEGS with LS and C-LS [r = 0.61 and 0.71, both p = 0.001]. The correlation with FC was stronger for MEGS than for LS or C-LS [r = 0.68 vs r = 0.46 vs r = 0.53, all p = 0.001]. The correlation between the proximal LS and MEGS was significant [r = 0.55, p = 0.001]; median MEGS was significantly different in patients, with LS values consistent with mucosal healing, mild and moderate-to-severe inflammation.
MEGS provides accurate evaluation of the SB and strongly correlates with FC; the main advantage of MEGS is the accurate quantification of proximal SB inflammation unavailable for alternative MRE scores.
胶囊内镜[CE]和磁共振肠造影术[MRE]是克罗恩病[CD]小肠评估的主要方式。MRE 检测 CD 近端小肠[SB]炎症具有挑战性。目前可用的定量 MRE 评分并未纳入近端 SB 数据。MRE 整体评分[MEGS]旨在对整个消化道进行定量评估；其在近端 SB 中的准确性尚未得到评估。本研究比较了 MEGS 和基于 CE 的定量评分（Lewis 评分[LS]）对小肠炎症的评估。
稳定临床缓解的 CD 患者前瞻性入组并接受 MRE 和 CE；获得粪便钙卫蛋白[FC]水平。计算每个 SB 节段和整个 SB[SBMEGS]的 MEGS。CE 上的 SB 炎症采用 LS 进行量化。基于三分位评分之和，计算累积 Lewis 评分[C-LS]。
共纳入 50 例患者。SBMEGS 与 LS 和 C-LS 呈显著相关[r = 0.61 和 0.71，均 p = 0.001]。与 LS 或 C-LS 相比，MEGS 与 FC 的相关性更强[r = 0.68 比 r = 0.46 比 r = 0.53，均 p = 0.001]。近端 LS 与 MEGS 的相关性具有统计学意义[r = 0.55，p = 0.001]；LS 值与黏膜愈合、轻度和中重度炎症一致的患者，MEGS 中位数存在显著差异。
MEGS 可准确评估 SB，与 FC 密切相关；MEGS 的主要优势是可准确量化替代 MRE 评分无法评估的近端 SB 炎症。
