Shoenut J P, Semelka R C, Magro C M, Silverman R, Yaffe C S, Micflikier A B
Department of Medicine, St. Boniface General Hospital, Winnipeg, Manitoba, Canada.
J Clin Gastroenterol. 1994 Jul;19(1):31-5. doi: 10.1097/00004836-199407000-00009.
Twenty consecutive patients with first-time presentation of suspected inflammatory bowel disease underwent both endoscopy with biopsy and magnetic resonance imaging (MRI) within a 3-day period; the relative abilities of endoscopy and MRI to distinguish ulcerative colitis (UC) from Crohn's disease (CD) and to determine the severity of the disease process were compared. In 18 of 20 patients, a diagnosis of UC or CD could be made on histological specimens. MRI correctly diagnosed 17 of these 18 patients using T1-weighted fat-suppressed spin echo and gadolinium enhancement. Endoscopy correctly diagnosed 15 patients. Overall, MRI was not significantly better (p > 0.05) than endoscopy in distinguishing UC from CD. MRI correctly graded the severity of inflammatory changes in 13 of 20 patients, and endoscopy did so in 11 of 20. MRI and endoscopy findings were within one grade of histology findings in seven patients each. No significant difference (p > 0.05) was found between MRI and endoscopy in the ability to estimate the severity of the disease (as determined from biopsies). Bowel wall thickness measured on MR images demonstrated good correlation with percentage of contrast enhancement: r = 0.61; p = 0.003. In sum, magnetic resonance imaging was shown to be comparable with endoscopy in differentiating UC from CD and in gauging the severity of disease. Transmural assessment, sagittal imaging, and the lack of invasiveness were attractive features of MRI.
20例首次疑似炎症性肠病的患者在3天内接受了内镜活检和磁共振成像（MRI）检查；比较了内镜和MRI区分溃疡性结肠炎（UC）和克罗恩病（CD）以及确定疾病严重程度的相对能力。20例患者中有18例可通过组织学标本做出UC或CD的诊断。MRI使用T1加权脂肪抑制自旋回波和钆增强技术正确诊断了这18例患者中的17例。内镜正确诊断了15例患者。总体而言，在区分UC和CD方面，MRI并不比内镜显著更好（p>0.05）。MRI正确分级了20例患者中13例炎症变化的严重程度，内镜正确分级了20例中的11例。MRI和内镜检查结果在7例患者中与组织学检查结果相差一个等级。在估计疾病严重程度（根据活检确定）方面，MRI和内镜之间未发现显著差异（p>0.05）。在MR图像上测量的肠壁厚度与对比剂增强百分比显示出良好的相关性：r = 0.61；p = 0.003。总之，磁共振成像在区分UC和CD以及评估疾病严重程度方面与内镜相当。透壁评估、矢状面成像以及非侵入性是MRI的吸引人之处。
