Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn's disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy
Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn's disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy
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DOI：
10.1136/gut.2004.041038
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发表时间：
2004-11-01
期刊：
影响因子：
24.5
通讯作者：
Porro, GB
中科院分区：
文献类型：
--
作者：
Parente, F;Greco, S;Porro, GB
背景/目的：虽然超声（US）已被证明在肠道疾病中是有用的，但钡肠灌肠（be）仍然是评估小肠克罗恩病（CD）患者的金标准技术。摄取消声不可吸收的溶液最近被提出，以扩大肠袢和改善小肠的可视化。与BE和回肠结肠镜检查相比，作者的目的是评估口服对比超声在发现CD病变、评估其在肠道内的范围和检测腔内并发症方面的准确性。方法：连续102例经证实的CD患者，经过完整的x线和内镜评估，纳入研究。每次US检查，在摄入聚乙二醇（PEG）溶液（500-800 ml）之前和之后，由两名不知道其他诊断程序结果的超声医师独立进行。确定了常规超声和增强超声在检测CD病变和管腔并发症以及肠受累程度方面的准确性。还估计了超声技师与两种美国技术之间的观察者间协议。结果：所有患者经口服造影剂后，均获得满意的肠腔膨胀，平均到达回肠末端时间为31.4分钟（SD 10.9）分钟。常规超声和口腔造影对CD病变的总体敏感性分别为91.4%和96.1%。食入PEG前US与回肠疾病x线范围的相关系数r(1) = 0.83 (p < 0.001)，食入PEG后r(2) = 0.94 (p < 0.001)；R(1)对R (2) p < 0.01。常规超声检测狭窄的灵敏度为74%，对比超声为89%。在摄入聚乙二醇之前，观察者之间对肠壁厚度和小肠内疾病位置的总体一致性已经很好，但在摄入聚乙二醇之后，一致性显著提高。结论：口服对比造影肠超声在确定CD的解剖位置和延伸方面与BE相当，在检测腔内并发症方面优于常规超声，并减少了超声医师之间观察者之间的差异。因此，它可被视为小肠CD诊断工作和随访中的第一个影像学程序。
Background/Aim: Although ultrasound ( US) has proved to be useful in intestinal diseases, barium enteroclysis ( BE) remains the gold standard technique for assessing patients with small bowel Crohn's disease ( CD). The ingestion of anechoic non-absorbable solutions has been recently proposed in order to distend intestinal loops and improve small bowel visualisation. The authors' aim was to evaluate the accuracy of oral contrast US in finding CD lesions, assessing their extent within the bowel, and detecting luminal complications, compared with BE and ileocolonoscopy.Methods: 102 consecutive patients with proven CD, having undergone complete x ray and endoscopic evaluation, were enrolled in the study. Each US examination, before and after the ingestion of a polyethylene glycol (PEG) solution (500-800 ml), was performed independently by two sonographers unaware of the results of other diagnostic procedures. The accuracy of conventional and contrast enhanced US in detecting CD lesions and luminal complications, as well as the extent of bowel involvement, were determined. Interobserver agreement between sonographers with both US techniques was also estimated.Results: After oral contrast, satisfactory distension of the intestinal lumen was obtained in all patients, with a mean time to reach the terminal ileum of 31.4 (SD 10.9) minutes. Overall sensitivity of conventional and oral contrast US in detecting CD lesions were 91.4% and 96.1%, respectively. The correlation coefficient between US and x ray extent of ileal disease was r(1) = 0.83 (p < 0.001) before and r(2) = 0.94 (p < 0.001) after PEG ingestion; r(1) versus r(2) p < 0.01. Sensitivity in detecting strictures was 74% for conventional US and 89% for contrast US. Overall interobserver agreement for bowel wall thickness and disease location within the small bowel was already good before but significantly improved after PEG ingestion.Conclusions: Oral contrast bowel US is comparable with BE in defining anatomic location and extension of CD and superior to conventional US in detecting luminal complications, as well as reducing interobserver variability between sonographers. It may be therefore regarded as the first imaging procedure in the diagnostic work up and follow up of small intestine CD.