在儿童炎症性肠病的磁共振小肠造影中，扩散加权成像能否替代钆增强成像？
Can diffusion weighting replace gadolinium enhancement in magnetic resonance enterography for inflammatory bowel disease in children?
作者信息
Khachab Farah, Loundou Anderson, Roman Céline, Colavolpe Nathalie, Aschero Audrey, Bourlière-Najean Brigitte, Daidj Nassima, Desvignes Catherine, Pico Harmony, Gorincour Guillaume, Auquier Pascal, Petit Philippe
机构信息
Pediatric Radiology Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, 264 Rue Saint-Pierre, 13385, Marseille Cedex 5, Marseille, France.
Public Health Department, Hopital de la Timone, Assistance Publique des Hopitaux de Marseille, Marseille, France.
出版信息
Pediatr Radiol. 2018 Sep;48(10):1432-1440. doi: 10.1007/s00247-018-4169-x. Epub 2018 Jul 7.
BACKGROUND
Contrast-enhanced MRI is often used for diagnosis and follow-up of children with inflammatory bowel disease.
OBJECTIVE
To compare the accuracy of diffusion-weighted MRI (DWI) to contrast-enhanced MRI in children with known or suspected inflammatory bowel disease.
MATERIALS AND METHODS
This retrospective, consecutive study included 55 children. We used ileo-colonoscopy and histology as the reference standard from the terminal ileum to the rectum, and contrast-enhanced MRI as the reference standard proximal to the terminal ileum. DWI and contrast-enhanced MRI sequences were independently reviewed and compared per patient and per segment to these reference standards and to the follow-up for each child.
RESULTS
We obtained endoscopic data for 340/385 colonic and ileal segments (88%). The rate of agreement per segment between DWI and endoscopy was 64%, and the rate of agreement between contrast-enhanced MRI and endoscopy was 59%. Per patient, sensitivity and specificity of bowel wall abnormalities as compared to the endoscopy were 87% and 100% for DWI, and 70% and 100% for contrast-enhanced MRI, respectively. Positive and negative predictive values were, respectively, 100% and 57% for DWI, and 96% and 41% for contrast-enhanced MRI. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of DWI compare to contrast-enhanced MRI in the segments proximal to the terminal ileum were 90%, 98%, 90%, 98% and 96%, respectively.
CONCLUSION
The diagnostic performance of DWI is competitive to that of contrast-enhanced MRI in children with known or suspected inflammatory bowel disease.
背景
对比增强磁共振成像（MRI）常用于炎症性肠病患儿的诊断及随访。
目的
比较扩散加权MRI（DWI）与对比增强MRI对已知或疑似炎症性肠病患儿的诊断准确性。
材料与方法
这项回顾性连续研究纳入了55名儿童。我们将从回肠末端至直肠的结肠和回肠结肠镜检查及组织学检查作为参考标准，将回肠末端近端的对比增强MRI作为参考标准。对每位患者和每个节段独立评估DWI和对比增强MRI序列，并与这些参考标准以及每个儿童的随访情况进行比较。
结果
我们获得了340/385个结肠和回肠节段的内镜数据（88%）。DWI与内镜检查每个节段的一致性率为64%，对比增强MRI与内镜检查的一致性率为59%。就每位患者而言，与内镜检查相比，DWI对肠壁异常的敏感性和特异性分别为87%和100%，对比增强MRI分别为70%和100%。DWI的阳性预测值和阴性预测值分别为100%和57%，对比增强MRI分别为96%和41%。在回肠末端近端节段，DWI与对比增强MRI相比的敏感性、特异性、阳性预测值、阴性预测值及准确性分别为90%、98%、90%、98%和96%。
结论
在已知或疑似炎症性肠病的患儿中，DWI的诊断性能与对比增强MRI相当。
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