Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark.
Department of Regional Health Research, University of Southern Denmark, Denmark.
Scand J Gastroenterol. 2023 Jul-Dec;58(12):1405-1411. doi: 10.1080/00365521.2023.2234538. Epub 2023 Jul 17.
Intestinal ultrasound (IUS) performed by experts is a valuable tool for the diagnostic work-up and monitoring of Crohn's disease (CD). However, concern about insufficient training and perceived high inter-observer variability limit the adoption of IUS in CD. We examined the diagnostic accuracy of trainee-performed IUS in patients with suspected CD.
Patients recruited to a prospective trial investigating the diagnostic accuracy of magnetic resonance enterocolonography (MREC) in patients with clinically suspected CD underwent IUS performed by trainees. The primary end-point was IUS per-patient sensitivity and specificity for ileocolonic CD determined by ileocolonoscopy.
129 patients with clinically suspected CD and a complete IC and IUS were included in the analysis. IUS detected signs of CD in 49 cases (small bowel 31, colon 15, small bowel, and colon 3). The sensitivity and specificity for detection of ileocolonic CD by trainee performed IUS improved during the first to the second half of the study period from 57.1% (CI 34.0-78.2) to 73.1% (CI 52.2-88.4) and 76.5% (CI 58.8-89.3) to 89.7% (CI 72.6-97.8). The overall sensitivity and specificity of diagnosing CD with IUS were 65.4% (CI 50.9-78.0) and 80.5% (CI 69.9-88.7). There was no difference in diagnostic performance between IUS and MREC for the detection of CD.
Trainees improved during the study, and IUS performance in disease detection corresponded to expert-evaluated MREC.
专家进行的肠内超声（IUS）是克罗恩病（CD）诊断和监测的有价值工具。然而，对培训不足的担忧和认为观察者间差异较大限制了 IUS 在 CD 中的应用。我们研究了受训者进行 IUS 对疑似 CD 患者的诊断准确性。
我们前瞻性研究了磁共振肠结肠成像（MREC）对疑似 CD 患者的诊断准确性，该研究纳入了接受 MREC 检查的患者。主要终点是通过回结肠镜检查确定的 IUS 对每位患者回肠结肠 CD 的敏感性和特异性。
129 例临床疑似 CD 且完整 IC 和 IUS 的患者纳入了分析。IUS 在 49 例患者中检测到 CD 征象（小肠 31 例，结肠 15 例，小肠和结肠 3 例）。受训者进行 IUS 对回肠结肠 CD 的检测敏感性和特异性在研究前半段到后半段期间从 57.1%（CI 34.0-78.2）增加到 73.1%（CI 52.2-88.4）和 76.5%（CI 58.8-89.3）增加到 89.7%（CI 72.6-97.8）。IUS 诊断 CD 的总体敏感性和特异性分别为 65.4%（CI 50.9-78.0）和 80.5%（CI 69.9-88.7）。IUS 和 MREC 在检测 CD 方面的诊断性能没有差异。
受训者在研究期间有所提高，并且 IUS 在疾病检测方面的表现与专家评估的 MREC 相当。
