Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Radiologia Diagnostica e Interventistica Generale, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Largo Francesco Vito, 1, 00168 Roma, Italy.
Clin Imaging. 2020 Jun;62:1-9. doi: 10.1016/j.clinimag.2020.01.020. Epub 2020 Jan 27.
Aim of this retrospective study is to evaluate the response to therapy in Crohn's disease (CD) patients studied by MR Enterography (MRE) in comparison with Harvey Bradshaw Index (HBI).
One hundred and sixty patients with histological proved CD have undergone MRE in the last years. Forty-six patients who repeated MRE after medical therapy within six months were selected for the study. Magnetic Resonance Index of Activity (MaRIA) was evaluated for each patient and used to define the MR judgment. In MRE we also evaluated wall thickening, longitudinal extension of wall thickening, presence of stratified mural hyperenhancement and extraintestinal signs. The clinical response to therapy was judged based on HBI and classified as improved, worsened or stable disease. Clinical judgment was correlated with MRE findings and the agreement was analysed using the Cohen Kappa test.
Among 46 enrolled patients, 18 (39%) improved clinically, 4 (10%) worsened, 24 (51%) remained stable. MR judgment was in agreement with clinical assessment in 33 patients (72%), showing moderate significant concordance (Kappa = 0.49; p < 0.01). No agreement was observed in 13 (28%) patients. Moreover, clinical improvement was significantly correlated to reduction of wall thickening, reduction of longitudinal extension of the disease and reduction of engorged vasa recta (p < 0.05). Worsening conditions were significantly correlated to increased wall thickening (p = 0.05).
MRE is useful in evaluating the response to therapy in CD patients.
本回顾性研究旨在通过磁共振肠造影术（MRE）评估与 Harvey Bradshaw 指数（HBI）相比，克罗恩病（CD）患者的治疗反应。
近年来，160 例组织学证实的 CD 患者接受了 MRE 检查。选择 46 例在 6 个月内接受药物治疗后重复 MRE 的患者进行研究。对每位患者进行磁共振活动指数（MaRIA）评估，并用于定义 MR 判断。在 MRE 中，我们还评估了壁增厚、壁增厚的纵向延伸、分层壁强化和肠外表现。根据 HBI 判断治疗的临床反应，并分为改善、恶化或疾病稳定。临床判断与 MRE 结果相关，并使用 Cohen Kappa 检验分析一致性。
在纳入的 46 例患者中，18 例（39%）临床改善，4 例（10%）恶化，24 例（51%）稳定。MR 判断与临床评估一致的有 33 例（72%），显示中度显著一致性（Kappa=0.49；p<0.01）。13 例（28%）患者无一致性。此外，临床改善与壁增厚减少、疾病纵向延伸减少和充盈的直肠直血管减少显著相关（p<0.05）。恶化情况与壁增厚增加显著相关（p=0.05）。
MRE 可用于评估 CD 患者的治疗反应。
