Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Gastroenterol Hepatol. 2020 Jul;35(7):1136-1142. doi: 10.1111/jgh.14945. Epub 2019 Dec 17.
Crohn's disease (CD) is a chronic and relapsing course with various status of different segments, and there were no investigations comparing the lesion detection between magnetic resonance (MR) and computed tomography (CT) in term of the severity of CD. We aim to assess the performances of diffusion-weighted MR enterography (DW-MRE) and contrast enhanced CT enterography (CTE) for detecting different grade lesions in ileocolonic CD.
Forty-one consecutive patients finally diagnosed with ileocolonic CD were included. All the patients prospectively underwent DW-MRE, contrast enhanced CTE, and ileocolonoscopy within 2 weeks. DW-MRE and CTE images were interpreted for the presence or absence of active CD segments by two experienced radiologists independently. Ileocolonic segments (terminal ileum, right colon, transverse colon, left colon, and rectum) were graded as inactive (0-2), mild (3-6), or moderate-severe (≥ 7) by the simplified endoscopic score for CD (SES-CD). Diagnostic efficiencies of DW-MRE and CTE for mild and/or moderate-severe CD segments were calculated and compared, using ileocolonoscopy as reference standard.
According to SES-CD, 190 ileocolonic segments from 41 CD patients were scored as 91 inactive, 68 mild, and 31 moderate-severe CD lesions. The sensitivity of DW-MRE for detecting active from inactive segments was higher than that of CTE, and the specificities of them had no significant differences. As for the subgroup analysis, DW-MRE was more sensitive for mild CD lesions than CTE (76.5% vs 60.3%; P = 0.019), while the sensitivities for moderate-severe CD were similar between these two modalities (96.8% for DW-MRE and 93.5% for CTE; P = 1.00).
Both DW-MRE and CTE had comparably excellent performances for moderate-severe CD detection; DW-MRE demonstrated better sensitivity in mild lesions compared with CTE and could be more suitable for the diagnosis of mild CD.
克罗恩病（CD）是一种慢性、复发性疾病，不同节段的疾病状态各不相同，目前尚无研究比较磁共振（MR）和计算机断层扫描（CT）在 CD 严重程度方面对病变的检出能力。本研究旨在评估扩散加权磁共振肠造影术（DW-MRE）和对比增强 CT 肠造影术（CTE）对检测回结肠 CD 不同病变程度的能力。
本研究共纳入 41 例最终诊断为回结肠 CD 的连续患者。所有患者在 2 周内前瞻性地接受了 DW-MRE、对比增强 CTE 和回结肠镜检查。由两位经验丰富的放射科医生独立对 DW-MRE 和 CTE 图像进行分析，以判断是否存在活动性 CD 肠段。通过简化的克罗恩病内镜评分（SES-CD）对回结肠节段（末端回肠、右结肠、横结肠、左结肠和直肠）进行无活动（0-2 分）、轻度（3-6 分）或中重度（≥7 分）的分级。以回结肠镜检查为参考标准，计算并比较 DW-MRE 和 CTE 对轻度和/或中重度 CD 节段的诊断效率。
根据 SES-CD，41 例 CD 患者的 190 个回结肠节段被评为 91 个无活动病变、68 个轻度病变和 31 个中重度病变。与 CTE 相比，DW-MRE 检测活动性病变的敏感性更高，而特异性无显著差异。在亚组分析中，DW-MRE 对轻度 CD 病变的敏感性优于 CTE（76.5%比 60.3%；P=0.019），而两种方法对中重度 CD 病变的敏感性相似（DW-MRE 为 96.8%，CTE 为 93.5%；P=1.00）。
DW-MRE 和 CTE 对中重度 CD 的检出能力相当；与 CTE 相比，DW-MRE 对轻度病变的敏感性更高，更适合诊断轻度 CD。
