Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Radiol. 2022 Jan;23(1):30-41. doi: 10.3348/kjr.2021.0072. Epub 2021 Sep 13.
Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are considered substitutes for each other for evaluating Crohn's disease (CD). However, the adequacy of mixing them for routine periodic follow-up for CD has not been established. This study aimed to compare MRE alone with the mixed use of CTE and MRE for the periodic follow-up of small bowel inflammation in patients with CD.
We retrospectively compared two non-randomized groups, each comprising 96 patients with CD. One group underwent CTE and MRE (MRE followed by CTE or vice versa) for the follow-up of CD (interval, 13-27 months [median, 22 months]), and the other group underwent MRE alone (interval, 15-26 months [median, 21 months]). However, these two groups were similar in clinical characteristics. Three independent readers from three different institutions determined whether inflammation had decreased, remained unchanged, or increased within the entire small bowel and the terminal ileum based on sequential enterography of the patients after appropriate blinding. We compared the two groups for inter-reader agreement and accuracy (terminal ileum only) using endoscopy as the reference standard for enterographic interpretation.
The inter-reader agreement was greater in the MRE alone group for the entire small bowel (intraclass correlation coefficient [ICC]: 0.683 vs. 0.473; = 0.005) and the terminal ileum (ICC: 0.656 vs. 0.490; = 0.030). The interpretation accuracy was higher in the MRE alone group without statistical significance (70.9%-74.5% vs. 57.9%-64.9% in individual readers; adjusted odds ratio = 3.21; = 0.077).
The mixed use of CTE and MRE was inferior to MRE alone in terms of inter-reader reliability and could probably be less accurate than MRE alone for routine monitoring of small bowel inflammation in patients with CD. Therefore, the consistent use of MRE is favored for this purpose.
计算机断层扫描肠造影术（CTE）和磁共振肠造影术（MRE）被认为可以相互替代，用于评估克罗恩病（CD）。然而，尚未确定将两者混合用于 CD 的常规定期随访是否足够。本研究旨在比较 MRE 单独使用与 CTE 和 MRE 混合使用对 CD 患者小肠炎症的定期随访。
我们回顾性比较了两组非随机患者，每组均包含 96 例 CD 患者。一组患者接受 CTE 和 MRE（MRE 后行 CTE 或反之亦然）进行 CD 随访（间隔 13-27 个月[中位数 22 个月]），另一组仅接受 MRE（间隔 15-26 个月[中位数 21 个月]）。然而，这两组患者的临床特征相似。三位来自三个不同机构的独立读者在适当的盲法后根据患者的连续肠造影确定整个小肠和末端回肠的炎症是否减轻、不变或加重。我们将这两组患者的读者间一致性和准确性（仅末端回肠）与内镜检查作为肠造影解释的参考标准进行了比较。
MRE 单独组患者的整个小肠（组内相关系数[ICC]：0.683 比 0.473；P=0.005）和末端回肠（ICC：0.656 比 0.490；P=0.030）的读者间一致性更高。MRE 单独组的解释准确性更高，但无统计学意义（70.9%-74.5%与各读者的 57.9%-64.9%；调整后的优势比=3.21；P=0.077）。
与 MRE 单独使用相比，CTE 和 MRE 的混合使用在读者间可靠性方面较差，并且在 CD 患者的小肠炎症常规监测方面可能不如 MRE 单独使用准确。因此，推荐一致使用 MRE 进行此项检查。
