NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA.
NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY, 10016, USA.
Abdom Radiol (NY). 2022 Oct;47(10):3424-3435. doi: 10.1007/s00261-022-03624-z. Epub 2022 Aug 2.
To retrospectively evaluate which key imaging features described by SAR-AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD.
52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index.
19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568-0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar.
Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.
回顾性评估 SAR-AGA 描述的哪些关键影像学特征与 CD 成人门诊监测 MRE 中的手术进展相关。
纳入了 2015 年 10 月至 2016 年 12 月期间进行门诊 MRE 成像且有可用临床信息的 52 例 CD 患者。两名腹部放射科医生审查了 MRE 以评估是否存在活跃性炎症、壁内水肿、限制扩散、狭窄、可能的狭窄、溃疡、囊状扩张、单纯性瘘管、复杂性瘘管、窦道、炎症性肿块、脓肿、肠周炎症、直肠直血管充血、纤维脂肪增生和肛周疾病。量化了肠壁厚度、受累肠段长度和狭窄处上游扩张程度。记录了随后的肠切除术、先前的肠手术和可用的实验室值。使用调整人口统计学、先前的肠手术、药物使用和体重指数的逻辑回归模型评估手术进展与影像学特征之间的关联。
19.2%（10/52）的患者进展为手术。在进展为手术的患者中，限制扩散、狭窄处上游扩张程度更大、复杂性瘘管、肠周炎症和纤维脂肪增生更为常见（均 p<0.05）。这些有意义的发现的 κ 值范围为 0.568-0.885。进展为手术的患者受累肠段长度更长（p=0.03）。血小板计数、ESR 和粪便钙卫蛋白显著升高，而血清白蛋白显著降低。进展为手术的患者中有先前的肠手术史，而性别、年龄和所有其他参数均相似。
放射科医生应仔细描述 CD 患者门诊 MRE 中狭窄处上游的肠扩张、穿透性和肠周表现，因为这些表现可能预示着手术进展。
