CT 肠造影与 MR 肠造影在诊断右侧深部浸润性肠子宫内膜异位症中的比较。
Comparison between CT-enterography and MR-enterography for the diagnosis of right-sided deep infiltrating endometriosis of the bowel.
机构信息
Department of Radiology, Hopital Cochin, AP-HP, 74014 Paris, France.
Department of Radiology, Hopital Cochin, AP-HP, 74014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France.
出版信息
Eur J Radiol. 2023 Apr;161:110730. doi: 10.1016/j.ejrad.2023.110730. Epub 2023 Feb 6.
OBJECTIVE
To compare computed tomography-enterography (CTE) and magnetic resonance-enterography (MRE) in the detection of right-sided bowel deep infiltrating endometriosis (DIE).
MATERIALS AND METHODS
Fifty women with DIE who underwent preoperatively CTE and MRE were included. CTE and MRE were first analyzed separately by two independent readers who analyzed five bowel segments (cecum, appendix, ileocecal junction, distal ileum and proximal small bowel [i.e., proximal ileum and jejunum]) for the presence of DIE and then interpreted in consensus. CTE, MRE and CTE with MRE were compared in terms of sensitivity, specificity and accuracy. Interobserver agreement was assessed with kappa (κ) test.
RESULTS
Using the reference standard 25 out 250 bowel segments were involved by DIE in 18 women and 225 were free of DIE. Sensitivity, specificity, and accuracy of CTE were 60% (95% confidence interval [CI]: 39-79), 93% (95% CI: 89-96) and 90% (95% CI: 85-93) for Reader 1, respectively, and 52% (95% CI: 31-72), 99% (95% CI: 97-100) and 94% (95% CI: 91-97) for Reader 2, with no differences in sensitivity (P = 0.564) and specificity (P = 0.181) between readers and fair interobserver agreement (κ = 0.37). For MRE these figures were 52% (95% CI: 31-72), 92% (95% CI: 88-95) and 88% (95% CI: 84-92) for Reader 1 and 60% (95% CI: 39-79), 99% (95% CI: 96-100) and 95% (95% CI: 91-97) for Reader 2, with no differences in sensitivity (P = 0.157) and specificity (P = 0.061) between readers and fair interobserver agreement (κ = 0.31). Significant differences in sensitivity (20%; 95% CI: 7-41) were found between CTE + MRE vs. CTE alone for Reader 1 and vs. MRE alone for Reader 2 (P = 0.041 for both) CONCLUSION: CTE and MRE have not different sensitivities and convey only fair interobserver agreement but are highly specific for the diagnosis of right-sided bowel DIE. CTE and MRE are complementary because they improve the detection of DIE implants when used in combination.
目的
比较计算机断层扫描肠造影术（CTE）和磁共振肠造影术（MRE）在检测右侧肠深部浸润性子宫内膜异位症（DIE）中的应用。
材料和方法
纳入 50 例经术前 CTE 和 MRE 检查的 DIE 患者。两名独立的读者首先分别对 5 个肠段（盲肠、阑尾、回盲部、回肠远端和近端小肠[即回肠近端和空肠]）进行 DIE 存在情况的 CTE 和 MRE 分析，然后进行共识解读。比较 CTE、MRE 和 CTE 联合 MRE 在敏感性、特异性和准确性方面的差异。采用 Kappa（κ）检验评估观察者间的一致性。
结果
使用参考标准，25 例患者的 250 个肠段中，18 例患者的 25 个肠段存在 DIE，225 个肠段无 DIE。Reader1 的 CTE 敏感性、特异性和准确性分别为 60%（95%CI：39-79）、93%（95%CI：89-96）和 90%（95%CI：85-93），Reader2 的敏感性、特异性和准确性分别为 52%（95%CI：31-72）、99%（95%CI：97-100）和 94%（95%CI：91-97），Reader1 和 Reader2 的敏感性（P=0.564）和特异性（P=0.181）差异无统计学意义，观察者间的一致性为中等（κ=0.37）。对于 MRE，Reader1 的敏感性、特异性和准确性分别为 52%（95%CI：31-72）、92%（95%CI：88-95）和 88%（95%CI：84-92），Reader2 的敏感性、特异性和准确性分别为 60%（95%CI：39-79）、99%（95%CI：96-100）和 95%（95%CI：91-97），Reader1 和 Reader2 的敏感性（P=0.157）和特异性（P=0.061）差异无统计学意义，观察者间的一致性为中等（κ=0.31）。Reader1 中 CTE+MRE 与 CTE 相比，敏感性（20%；95%CI：7-41）有显著差异（P=0.041），Reader2 中 CTE+MRE 与 MRE 相比，敏感性（20%；95%CI：7-41）有显著差异（P=0.041）。
结论
CTE 和 MRE 的敏感性无差异，且仅具有中等观察者间一致性，但对右侧肠 DIE 的诊断具有高度特异性。CTE 和 MRE 是互补的，因为它们联合使用时可以提高 DIE 植入物的检出率。
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