Department of Abdominal and Interventional Imaging, Hôpital Cochin, AP-HP, 27 rue du Faubourg St Jacques, 75014, Paris, France.
UMR INSERM 965, Hôpital Lariboisière, 2 rue Amboise Paré, 75010, Paris, France.
Eur Radiol. 2019 Apr;29(4):2034-2044. doi: 10.1007/s00330-018-5734-2. Epub 2018 Oct 9.
To compare the accuracy of MR enterography (MRE) using combined T2-weighted and contrast-enhanced (CE) sequences with that of combined T2- and diffusion-weighted (DW) sequences for the detection of complex enteric Crohn's disease (CD).
Thirty-eight patients who underwent surgery for CD complications and preoperative MRE from 2011 to 2016 were included. MRE examinations were blindly analyzed independently by one junior and one senior abdominal radiologist for the presence of fistula, stenosis and abscesses. During a first reading session, T2-weighted images (WI), steady-state sequences and DW-MRE were reviewed (set 1). During a separate distant session, T2-WI, True-FISP and CE-MRE were reviewed (set 2). Performance of each reader was evaluated by comparison with the standard of reference established using intraoperative and pathological findings.
Forty-eight fistulas, 43 stenoses and 11 abscesses were found. For the senior radiologist, sensitivity for the detection of fistula, stenosis and abscess ranged from 80% to 100% for set 1 and 88% to 100% for set 2 and specificity ranged from 56% to 70% for set 1 and 53% to 93% for set 2, with no significant difference between the sets (p = 0.342-0.429). For the junior radiologist, sensitivity ranged from 53% to 63% for set 1 and 64% to 88% for set 2 and specificity ranged from 0% to 25% for set 1 and 17% to 40% for set 2 (p = 0.001 and 0.007, respectively).
For a senior radiologist, DW-MRE has similar sensitivity as CE-MRE for the detection of CD complications. For a junior radiologist, CE-MRE yields the best results compared with DW-MRE.
• For experienced readers, DWI has similar diagnostic capability as contrast-enhanced MR imaging for the diagnosis of Crohn's disease complications. • For senior radiologists, gadolinium chelate injection could be waived for the diagnosis of Crohn's disease complications. • The interpretation of DWI for Crohn's disease complications requires some experience.
比较磁共振肠造影术（MRE）联合 T2 加权和对比增强（CE）序列与联合 T2 加权和扩散加权（DW）序列检测复杂肠克罗恩病（CD）的准确性。
纳入 2011 年至 2016 年间因 CD 并发症而行手术治疗并接受术前 MRE 的 38 例患者。MRE 检查由一位初级和一位高级腹部放射科医师独立进行盲法分析，以评估瘘管、狭窄和脓肿的存在。在第一次阅读会议期间，回顾 T2 加权图像（WI）、稳态序列和 DW-MRE（组 1）。在单独的远程会议期间，回顾 T2-WI、True-FISP 和 CE-MRE（组 2）。通过与术中及病理发现建立的标准参考比较，评估每位读者的表现。
发现 48 个瘘管、43 个狭窄和 11 个脓肿。对于高级放射科医师，组 1 检测瘘管、狭窄和脓肿的敏感性为 80%至 100%，组 2 为 88%至 100%，特异性为 56%至 70%，组 1 为 53%至 93%，两组之间无显著差异（p = 0.342-0.429）。对于初级放射科医师，组 1 的敏感性为 53%至 63%，组 2 的敏感性为 64%至 88%，组 1 的特异性为 0%至 25%，组 2 的特异性为 17%至 40%（p = 0.001 和 0.007）。
对于经验丰富的放射科医师，DW-MRE 对 CD 并发症的检测具有与 CE-MRE 相似的敏感性。对于初级放射科医师，CE-MRE 比 DW-MRE 产生更好的结果。
• 对于有经验的读者，DWI 对诊断克罗恩病并发症具有与增强磁共振成像相似的诊断能力。• 对于高级放射科医师，可免除诊断克罗恩病并发症时使用钆螯合物注射。• 对 DWI 进行解释需要一些经验。
