Department of Internal Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany.
Department of Internal Medicine, Krankenhäuser Nürnberger Land GmbH, Simonshofer Str. 55, 91207, Lauf, Germany.
Abdom Radiol (NY). 2021 May;46(5):1855-1863. doi: 10.1007/s00261-020-02895-8. Epub 2020 Dec 24.
We evaluated ileal bowel wall thickness and semiquantitative vascularization by ultrasound in correlation with the presence or absence of histopathological inflammation in patients with Crohn's disease (CD).
We conducted a retrospective analysis of 221 ultrasound examinations of the terminal ileum or neoterminal ileum in CD patients with biopsies of the ileum during colonoscopies within 8 weeks of the ultrasound. Ultrasound data were obtained from an inflammatory bowel disease ultrasound register from 2011 to 2017. Bowel wall ultrasound was performed by a high-frequency, linear transducer (7-12 MHz). Presence of bowel wall thickening (> 3 mm), vascularization by the Limberg score, and presence of ileal histopathological inflammation were analyzed.
In 221 bowel wall ultrasound examinations of CD patients (128 female, 93 male, mean age 37.5 years), a thickened bowel wall was found in 140 (63.3%) and hypervascularization (corresponding to a Limberg score ≥ 2) in 96 (43.4%) cases. In 187 (84.6%) cases, ileal inflammation was confirmed by histopathology and in 34 (15.4%) cases no inflammation was shown. Bowel wall thickening showed a sensitivity of 70.1%, a negative predictive value (NPV) of 30.9%, a specificity of 73.5% and a positive predictive value (PPV) of 93.6% for the detection of histopathological ileal inflammation. Hypervasularization had a low sensitivity (49.7%) and NPV (24.8%), but high specificity (91.2%) and PPV (96.9%).
In this CD subcohort of an ultrasound register, pathologic ultrasound findings were quite common. Bowel wall thickening (> 3 mm) and hypervascularization are good predictors of histopathological inflammation within the terminal ileum or neoterminal ileum. Normal ultrasound findings without bowel wall thickening and without hypervascularization do not rule out histopathological inflammation.
我们评估了回肠壁厚度和半定量血管化，以与克罗恩病（CD）患者的回肠组织病理学炎症的存在或不存在相关。
我们对 2011 年至 2017 年期间，221 例 CD 患者在结肠镜检查的 8 周内进行回肠活检的回肠末端或新回肠末端的超声检查进行了回顾性分析。超声数据来自炎症性肠病超声登记处。使用高频线性换能器（7-12MHz）进行肠壁超声检查。分析肠壁增厚（>3mm）、Limberg 评分的血管化以及回肠组织病理学炎症的存在。
在 221 例 CD 患者的回肠壁超声检查中（128 例女性，93 例男性，平均年龄 37.5 岁），140 例（63.3%）存在肠壁增厚，96 例（43.4%）存在高血管化（对应 Limberg 评分≥2）。187 例（84.6%）病例的回肠炎症通过组织病理学证实，34 例（15.4%）病例无炎症。肠壁增厚对组织病理学回肠炎症的检测具有 70.1%的敏感性、30.9%的阴性预测值（NPV）、73.5%的特异性和 93.6%的阳性预测值（PPV）。高血管化具有低敏感性（49.7%）和 NPV（24.8%），但高特异性（91.2%）和 PPV（96.9%）。
在这个超声登记处的 CD 亚组中，病理超声发现相当常见。肠壁增厚（>3mm）和高血管化是回肠末端或新回肠末端组织病理学炎症的良好预测指标。没有肠壁增厚和高血管化的正常超声表现并不能排除组织病理学炎症。
