大卫对阵歌利亚：手持式肠道超声与磁共振肠道成像诊断克罗恩病的直接比较。

David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn's Disease.

机构信息

Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy.

Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy.

出版信息

Inflamm Bowel Dis. 2023 Apr 3;29(4):563-569. doi: 10.1093/ibd/izac116.

DOI:10.1093/ibd/izac116

PMID:35666249

Abstract

BACKGROUND

Diagnosis of Crohn's disease (CD) requires ileo-colonoscopy (IC) and cross-sectional evaluation. Recently, "echoscopy" has been used effectively in several settings, although data about its use for CD diagnosis are still limited. Our aim was to evaluate the diagnostic accuracy of handheld bowel sonography (HHBS) in comparison with magnetic resonance enterography (MRE) for CD diagnosis.

METHODS

From September 2019 to June 2021, we prospectively recruited consecutive subjects attending our third level IBD Unit for suspected CD. Patients underwent IC, HHBS, and MRE in random order with operators blinded about the result of the other procedures. Bivariate correlation between MRE and HHBS was calculated by Spearman coefficient (r). To test the consistency between MRE and HHBS for CD location and complications, the Cohen's k measure was applied.

RESULTS

Crohn's disease diagnosis was made in 48 out of 85 subjects (56%). Sensitivity, specificity, positive predictive values, and negative predictive values for CD diagnosis were 87.50%, 91.89%, 93.33%, and 85% for HHBS; and 91.67%, 94.59%, 95.65%, and 89.74% for MRE, without significant differences in terms of diagnostic accuracy (89.41% for HHBS vs 92.94% for MRE, P = NS). Magnetic resonance enterography was superior to HHBS in defining CD extension (r = 0.67; P < .01) with a better diagnostic performance than HHBS for detecting location (k = 0.81; P < .01), strictures (k = 0.75; P < .01), abscesses (k = 0.68; P < .01), and fistulas (k = 0.65; P < .01).

CONCLUSION

Handheld bowel sonography and MRE are 2 accurate and noninvasive procedures for diagnosis of CD, although MRE is more sensitive in defining extension, location, and complications. Handheld bowel sonography could be used as effective ambulatory (or out-of-office) screening tool for identifying patients to refer for MRE examination due to high probability of CD diagnosis.

摘要

背景

克罗恩病（CD）的诊断需要进行回肠结肠镜检查（IC）和横断面评估。最近，“超声内镜”在多种情况下得到了有效应用，尽管其在 CD 诊断中的应用数据仍有限。我们的目的是评估手持式肠超声（HHBS）与磁共振肠造影术（MRE）在 CD 诊断中的诊断准确性。

方法

从 2019 年 9 月至 2021 年 6 月，我们前瞻性地招募了连续就诊于我们三级 IBD 专科的疑似 CD 患者。患者以随机顺序接受 IC、HHBS 和 MRE 检查，操作者对其他检查结果不知情。采用 Spearman 系数（r）计算 MRE 和 HHBS 之间的双变量相关性。为了检验 MRE 和 HHBS 在 CD 部位和并发症方面的一致性，应用 Cohen's k 测量。

结果

48 例（56%）85 例患者中确诊为 CD。HHBS 诊断 CD 的敏感性、特异性、阳性预测值和阴性预测值分别为 87.50%、91.89%、93.33%和 85%；MRE 分别为 91.67%、94.59%、95.65%和 89.74%，诊断准确性无显著差异（HHBS 为 89.41%，MRE 为 92.94%，P=NS）。MRE 在定义 CD 延伸方面优于 HHBS（r=0.67；P<0.01），在定位（k=0.81；P<0.01）、狭窄（k=0.75；P<0.01）、脓肿（k=0.68；P<0.01）和瘘管（k=0.65；P<0.01）方面的诊断性能优于 HHBS。