磁共振肠道成像、小肠超声和结肠镜检查用于诊断和分期克罗恩病：患者的接受度和感知负担。

Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn's disease: patient acceptability and perceived burden.

机构信息

Department of Psychological Sciences, Birkbeck, University of London, Malet Street, London, WC1E 7HX, UK.

Centre for Medical Imaging, University College London, Charles Bell House, 43-45, Foley Street, London, W1W 7TS, UK.

出版信息

Eur Radiol. 2019 Mar;29(3):1083-1093. doi: 10.1007/s00330-018-5661-2. Epub 2018 Aug 20.

OBJECTIVES

To compare patient acceptability and burden of magnetic resonance enterography (MRE) and ultrasound (US) to each other, and to other enteric investigations, particularly colonoscopy.

METHODS

159 patients (mean age 38, 94 female) with newly diagnosed or relapsing Crohn's disease, prospectively recruited to a multicentre diagnostic accuracy study comparing MRE and US completed an experience questionnaire on the burden and acceptability of small bowel investigations between December 2013 and September 2016. Acceptability, recovery time, scan burden and willingness to repeat the test were analysed using the Wilcoxon signed rank and McNemar tests; and group differences in scan burden with Mann-Whitney U and Kruskal-Wallis tests.

RESULTS

Overall, 128 (88%) patients rated MRE as very or fairly acceptable, lower than US (144, 99%; p < 0.001), but greater than colonoscopy (60, 60%; p < 0.001). MRE recovery time was longer than US (p < 0.001), but shorter than colonoscopy (p < 0.001). Patients were less willing to undergo MRE again than US (127 vs. 133, 91% vs. 99%; p = 0.012), but more willing than for colonoscopy (68, 75%; p = 0.017). MRE generated greater burden than US (p < 0.001), although burden scores were low. Younger age and emotional distress were associated with greater MRE and US burden. Higher MRE discomfort was associated with patient preference for US (p = 0.053). Patients rated test accuracy as more important than scan discomfort.

CONCLUSIONS

MRE and US are well tolerated. Although MRE generates greater burden, longer recovery and is less preferred than US, it is more acceptable than colonoscopy. Patients, however, place greater emphasis on diagnostic accuracy than burden.

KEY POINTS

• MRE and US are rated as acceptable by most patients and superior to colonoscopy. • MRE generates significantly greater burden and longer recovery times than US, particularly in younger patients and those with high levels of emotional distress. • Most patients prefer the experience of undergoing US than MRE; however, patients rate test accuracy as more importance than scan burden.

目的

比较磁共振肠造影术（MRE）和超声（US）与彼此以及其他肠内检查（特别是结肠镜检查）的患者可接受性和负担。

方法

2013 年 12 月至 2016 年 9 月，一项比较 MRE 和 US 的多中心诊断准确性研究前瞻性招募了 159 例新诊断或复发的克罗恩病患者，患者完成了一份关于小肠检查负担和可接受性的体验问卷。使用 Wilcoxon 符号秩和检验和 McNemar 检验分析可接受性、恢复时间、扫描负担和重复测试的意愿；使用 Mann-Whitney U 和 Kruskal-Wallis 检验分析扫描负担的组间差异。

结果

总体而言，128 例（88%）患者认为 MRE 非常或相当可接受，低于 US（144 例，99%；p < 0.001），但高于结肠镜检查（60 例，60%；p < 0.001）。MRE 恢复时间长于 US（p < 0.001），但短于结肠镜检查（p < 0.001）。与 US 相比，患者再次进行 MRE 的意愿较低（127 例 vs. 133 例，91% vs. 99%；p = 0.012），但比结肠镜检查更愿意进行（68 例，75%；p = 0.017）。MRE 引起的负担大于 US（p < 0.001），尽管负担评分较低。年龄较小和情绪困扰与更大的 MRE 和 US 负担相关。更高的 MRE 不适与患者对 US 的偏好相关（p = 0.053）。患者将测试准确性评估为比扫描不适更重要。