Zhang Minping, Xiao Enhua, Liu Minghui, Mei Xilong, Dai Yinghuan
Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, Changsha 410011, China.
Diagnostics (Basel). 2023 Jun 5;13(11):1980. doi: 10.3390/diagnostics13111980.
Distinguishing between inflammatory and fibrotic lesions drastically influences treatment decision-making regarding Crohn's disease. However, it is challenging to distinguish these two phenotypes before surgery. This study investigates the diagnostic yield of shear-wave elastography and computed tomography enterography to distinguish intestinal phenotypes in Crohn's disease. Thirty-seven patients (mean age, 29.51 ± 11.52; 31 men) were evaluated with average value of shear-wave elastography (Emean) and computed tomography enterography (CTE) scores. The results demonstrated that a positive correlation between the Emean and fibrosis (Spearman's r = 0.653, = 0.000). The cut-off value for fibrotic lesions was 21.30 KPa (AUC: 0.877, sensitivity: 88.90%, specificity: 89.50%, 95% CI:0.7550.999, = 0.000). The CTE score showed a positive correlation with inflammation (Spearman's r = 0.479, = 0.003), and a 4.5-point grading system was the optimal cut-off value for inflammatory lesions (AUC: 0.766, sensitivity: 73.70%, specificity: 77.80%, 95% CI: 0.5960.936, = 0.006). Combining these two metrics improved the diagnostic performance and specificity (AUC: 0.918, specificity: 94.70%, 95% CI: 0.806~1.000, = 0.000). In conclusion, shear-wave elastography can be used to help detect fibrotic lesions and the computed tomography enterography score emerged as a feasible predictor of inflammatory lesions. The combination of these two imaging techniques is proposed to distinguish intestinal predominant phenotypes.
区分炎症性病变和纤维化病变对克罗恩病的治疗决策有重大影响。然而，在手术前区分这两种表型具有挑战性。本研究调查了剪切波弹性成像和计算机断层扫描小肠造影在区分克罗恩病肠道表型方面的诊断效能。对37例患者（平均年龄29.51±11.52岁；男性31例）进行了剪切波弹性成像平均值（Emean）和计算机断层扫描小肠造影（CTE）评分评估。结果表明，Emean与纤维化之间存在正相关（Spearman相关系数r = 0.653，P = 0.000）。纤维化病变的截断值为21.30千帕（曲线下面积：0.877，敏感性：88.90%，特异性：89.50%，95%置信区间：0.7550.999，P = 0.000）。CTE评分与炎症呈正相关（Spearman相关系数r = 0.479，P = 0.003），4.5分分级系统是炎症性病变的最佳截断值（曲线下面积：0.766，敏感性：73.70%，特异性：77.80%，95%置信区间：0.5960.936，P = 0.006）。将这两个指标结合可提高诊断性能和特异性（曲线下面积：0.918，特异性：94.70%，95%置信区间：0.806~1.000，P = 0.000）。总之，剪切波弹性成像可用于帮助检测纤维化病变，计算机断层扫描小肠造影评分是炎症性病变的可行预测指标。建议联合使用这两种成像技术来区分肠道主要表型。
