在磁共振小肠造影中区分反流性回肠炎与克罗恩病末端回肠炎的实用指标

A Practical Index to Distinguish Backwash Ileitis From Crohn's Terminal Ileitis in MR Enterography.

作者信息

Khosravi Bardia, Salehnia Aneseh, Pak Neda, Montazeri S Ali, Sima Ali Reza, Vahedi Homayoun, Malekzadeh Reza, Radmard Amir Reza

机构信息

Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Department of Radiology, Mayo Clinic, Florida, USA.

出版信息

Inflamm Bowel Dis. 2023 Jan 5;29(1):42-50. doi: 10.1093/ibd/izac040.

DOI:10.1093/ibd/izac040

PMID:35259254

Abstract

BACKGROUND

Differentiating ulcerative colitis-associated "backwash" ileitis (BWI) from Crohn's terminal ileitis (CTI) is a diagnostic challenge and highly affects patient's management. This study aimed to investigate magnetic resonance enterography (MRE) features including ileocecal valve patency index (ICPI) in patients with BWI and CTI and distinguish these entities based on MRE findings.

METHODS

After obtaining institutional review board approval, we reviewed 1654 MREs; 60 patients with pathologically proven BWI (n = 30) and CTI (n = 30) were enrolled. Two radiologists who were blinded to the clinical diagnosis analyzed MREs. We evaluated bowel wall thickness and enhancement pattern, ileocecal valve (ICV) diameter, and lip thickness. Ileocecal valve patency index-T and ICPI-C were calculated to normalize the ICV diameter with respect to terminal ileum (TI) and cecum, respectively. An additional group of non-BWI-UC patients (n = 30) was also included to validate indices.

RESULTS

Circumferential mural thickening (90% vs 1%, P < .001) and inner-wall enhancement (P < .001) of TI were more frequent in BWI patients than CTI. Serosal irregularity (53% vs 13%, P = .002), higher mural thickness (5mm vs 3mm, P < .001), and asymmetric hyperenhancement (P < .001) of TI were more prevalent in CTI than BWI. Ileocecal valve patency and lip atrophy were significantly higher in BWI than CTI and non-BWI-UC groups (both P < .001). Ileocecal valve patency indices-C and ICPI-T indices were able to accurately distinguish BWI from CTI (area under the ROC curve [AUC], 0.864 and 0.847 for ICPI-T and ICPI-C, respectively) and non-BWI-UC (AUC, 0.777 and 0.791 for ICPI-T and ICPI-C, respectively). Ileocecal valve patency indices-T ≥31.5% were 100% specific to distinguish BWI from CTI, but sensitivity was 63%.

CONCLUSIONS

Magnetic resonance enterography features of ICV and TI can accurately differentiate BWI from CTI. Two practical indices introduced in this study showed high specificity to distinguish BWI from CTI.

摘要

背景

鉴别溃疡性结肠炎相关的“反流性”回肠炎（BWI）和克罗恩病末端回肠炎（CTI）是一项诊断挑战，对患者的治疗管理有很大影响。本研究旨在调查BWI和CTI患者的磁共振小肠造影（MRE）特征，包括回盲瓣通畅指数（ICPI），并根据MRE结果区分这两种疾病。

方法

获得机构审查委员会批准后，我们回顾了1654例MRE检查；纳入60例经病理证实的BWI（n = 30）和CTI（n = 30）患者。两名对临床诊断不知情的放射科医生分析MRE检查结果。我们评估肠壁厚度和强化模式、回盲瓣（ICV）直径和唇厚度。计算回盲瓣通畅指数-T和ICPI-C，分别将ICV直径相对于末端回肠（TI）和盲肠进行标准化。还纳入了另一组非BWI-UC患者（n = 30）以验证各项指数。

结果

BWI患者中TI的环形壁增厚（90%对1%，P <.001）和内壁强化（P <.001）比CTI患者更常见。CTI患者中TI的浆膜不规则（53%对13%，P =.002）、更高的壁厚度（5mm对3mm，P <.001）和不对称强化（P <.001）比BWI患者更普遍。BWI患者的回盲瓣通畅和唇萎缩显著高于CTI和非BWI-UC组（均P <.001）。回盲瓣通畅指数-C和ICPI-T指数能够准确区分BWI和CTI（ICPI-T和ICPI-C的ROC曲线下面积[AUC]分别为0.864和0.847）以及非BWI-UC（ICPI-T和ICPI-C的AUC分别为0.777和0.791）。回盲瓣通畅指数-T≥31.5%对区分BWI和CTI具有100%的特异性，但敏感性为63%。