Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
Clin Gastroenterol Hepatol. 2021 May;19(5):908-921.e6. doi: 10.1016/j.cgh.2020.07.067. Epub 2020 Aug 7.
BACKGROUND & AIMS: The accuracy of ultrasound for evaluation of individual colorectal segments in patients with inflammatory bowel diseases (IBD) has not been evaluated in a systematic review. We evaluated the diagnostic accuracy of ultrasound in different colorectal segments of patients with IBD.
We searched publication databases from inception through March 2019 for studies that assessed the accuracy of ultrasound in detection of inflammation in right, transverse, and left colon and in rectum in patients with IBD, using findings from colonoscopy as the reference standard. Subgroup analyses were performed including IBD type, patient age, body mass index, and study design. The risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Nineteen studies (1101 patients) were included in the qualitative synthesis. After we assessed the risk of bias, 7 studies (comprising 84 patients with Crohn's disease and 420 patients with ulcerative colitis) were included in the meta-analysis. Bowel wall thickness ≥ 3 mm identified colorectal segments with inflammation with 86.4% pooled sensitivity (95% CI, 76.1%-92.7%) and 88.3% pooled specificity (95% CI, 58.1%-97.6%). In rectum only, bowel wall thickness ≥ 3 mm identified inflammation with 74.5% sensitivity (95% CI, 53.0%-88.3%) and 69.5% specificity (95% CI, 33.6%-91.1%). Diagnostic accuracy was comparable among subgroups. Increased bowel wall flow and loss of stratification had higher true-positive odds ratios.
Based on meta-analysis of patient-level data, ultrasound has higher diagnostic accuracy for detecting inflammation in colon than rectum in patients with IBD. Studies are needed to increase the accuracy of ultrasound detection of inflammation in rectum.
在系统评价中，尚未评估超声在评估炎症性肠病（IBD）患者单个结直肠段中的准确性。我们评估了超声在 IBD 患者不同结直肠段中的诊断准确性。
我们从建库至 2019 年 3 月检索了评估超声在 IBD 患者右、横、左结肠和直肠中检测炎症准确性的研究，以结肠镜检查结果为参考标准。进行了包括 IBD 类型、患者年龄、体重指数和研究设计在内的亚组分析。使用诊断准确性研究质量评估-2 工具评估偏倚风险。
纳入了 19 项研究（共 1101 例患者）进行定性综合分析。在评估了偏倚风险后，纳入了 7 项研究（包括 84 例克罗恩病患者和 420 例溃疡性结肠炎患者）进行荟萃分析。肠壁厚度≥3mm 诊断结直肠段炎症的敏感性为 86.4%（95%CI，76.1%-92.7%），特异性为 88.3%（95%CI，58.1%-97.6%）。仅在直肠中，肠壁厚度≥3mm 诊断炎症的敏感性为 74.5%（95%CI，53.0%-88.3%），特异性为 69.5%（95%CI，33.6%-91.1%）。亚组之间的诊断准确性相当。增加肠壁血流和分层丧失具有更高的真阳性比值比。
基于患者水平数据的荟萃分析，超声诊断 IBD 患者结肠炎症的准确性高于直肠。需要进一步研究来提高超声检测直肠炎症的准确性。
