Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
BMC Gastroenterol. 2019 Jun 26;19(1):106. doi: 10.1186/s12876-019-1030-0.
Accurate evaluation of anti-tubercular therapy (ATT) responses is crucial for both diagnosis and treatment of intestinal tuberculosis (ITB). Little is known about the role of cross-sectional imaging techniques in ITB follow-up assessment. We aimed to investigate the accuracy of cross-sectional imaging modalities, CT enterography (CTE) and gastrointestinal ultrasound (GIUS), in the evaluation of ATT responses in ITB patients.
Patients diagnosed with ITB and followed up by CTE and/or GIUS were retrospectively searched in the databases. Clinical, imaging, laboratory and endoscopic data were collected at baseline and the first follow-up visit. Responses were graded as good, partial and no response based on protocols described in the literature and by our institution. CTE evaluation was based on changes in the lesion area, mural thickness, enhancement patterns and lymph nodes, while GIUS evaluation was based on changes in bowel wall morphology and the Limberg score. Clinical evaluation was used as the gold-standard evaluation method, which was determined by a comprehensive impression of endoscopic changes along with symptomatic improvement and laboratory tests, with imaging results masked.
Twenty patients with ITB were enrolled in our study. The first follow-up time was from 2 to 12 months (average 6 months). According to the gold standard evaluation, 11 patients were evaluated as having a good ATT response, while 9 had a partial response. A total of 18 patients were followed up by CTE, while 7 were followed up by GIUS, depending on medical and/or financial considerations. The accuracy of CTE and GIUS was 83% (15/18) and 85.7% (6/7), respectively. The sensitivity, specificity, PPV and NPV of CTE were 88.9, 77.8, 80 and 87.5%, respectively. Moreover, the sensitivity, specificity, PPV and NPV of GIUS were 100, 50, 83.3 and 100%, respectively. By combining the results of CTE and GIUS results, the overall accuracy was 90%, with sensitivity and specificity of 91.7 and 87.5%, respectively.
To our knowledge, this is the first study exploring the accuracy of the cross-sectional imaging modalities CTE/GIUS in the evaluation of ATT responses. Our results indicated their promising application prospect in clinical practice as a non-invasive and cost-effective approach.
准确评估抗结核治疗（ATT）反应对于肠结核（ITB）的诊断和治疗都至关重要。关于横断面成像技术在 ITB 随访评估中的作用，人们知之甚少。我们旨在研究 CT 肠造影（CTE）和胃肠超声（GIUS）在评估 ITB 患者 ATT 反应中的准确性。
我们在数据库中回顾性检索了经 CTE 和/或 GIUS 随访的 ITB 患者。在基线和第一次随访时收集临床、影像学、实验室和内镜数据。根据文献和我们机构的方案，将反应分为良好、部分和无反应。CTE 评估基于病变面积、壁层厚度、增强模式和淋巴结的变化，而 GIUS 评估基于肠壁形态和 Limberg 评分的变化。临床评估被用作金标准评估方法，该方法通过综合内镜变化的印象以及症状改善和实验室检查来确定，同时对成像结果进行了屏蔽。
我们纳入了 20 例 ITB 患者进行研究。第一次随访时间为 2 至 12 个月（平均 6 个月）。根据金标准评估，11 例患者的 ATT 反应良好，9 例患者的 ATT 反应部分良好。共有 18 例患者接受了 CTE 随访，7 例患者接受了 GIUS 随访，这取决于医疗和/或经济考虑。CTE 和 GIUS 的准确性分别为 83%（15/18）和 85.7%（6/7）。CTE 的敏感性、特异性、PPV 和 NPV 分别为 88.9%、77.8%、80%和 87.5%。此外，GIUS 的敏感性、特异性、PPV 和 NPV 分别为 100%、50%、83.3%和 100%。通过结合 CTE 和 GIUS 的结果，整体准确性为 90%，敏感性和特异性分别为 91.7%和 87.5%。
据我们所知，这是第一项探索 CTE/GIUS 横断面成像技术在评估 ATT 反应中的准确性的研究。我们的结果表明，它们具有作为一种非侵入性和具有成本效益的方法在临床实践中的应用前景。
