Real-Time Shear Wave Ultrasound Elastography Differentiates Fibrotic from Inflammatory Strictures in Patients with Crohn's Disease.
Real-Time Shear Wave Ultrasound Elastography Differentiates Fibrotic from Inflammatory Strictures in Patients with Crohn's Disease.
复制标题
实时剪切波超声弹性成像可区分克罗恩病患者的纤维化狭窄和炎症性狭窄。
DOI：
10.1093/ibd/izy115
复制
发表时间：
2018-09-15
影响因子：
4.9
通讯作者：
Chen MH
中科院分区：
文献类型：
--
作者：
Chen YJ;Mao R;Li XH;Cao QH;Chen ZH;Liu BX;Chen SL;Chen BL;He Y;Zeng ZR;Ben-Horin S;Rimola J;Rieder F;Xie XY;Chen MH
背景与目的
克罗恩病（CD）相关狭窄中肠纤维化与炎症的区别具有重要的治疗意义。超声弹性成像在评估肝脏纤维化程度方面是有用的，但很少有证据表明它可以评估肠道纤维化。我们确定了剪切波弹性成像（SWE），一种新的弹性成像改进，量化组织硬度，是否可以区分CD患者狭窄中的炎症和纤维化成分。
方法
入组了在手术切除前1周内接受SWE的伴有回肠/回结肠狭窄的连续性CD患者。将狭窄肠壁的SWE值分别与切除的肠标本中纤维化和炎症的等级和严重程度进行比较。
结果
入组了35例患者。重度纤维化狭窄肠壁SWE值（23.0 ± 6.3 Kpa）明显高于中度纤维化狭窄肠壁SWE值（17.4 ± 3.8 Kpa）和轻度纤维化狭窄肠壁SWE值（14.4 ± 2.1 Kpa）（P = 0.008）。以22.55KPa为界值区分轻、中、重度肝纤维化的敏感性和特异性分别为69.6%和91.7%，曲线下面积（AUC）为0.822（P = 0.002）。然而，在不同级别的炎症之间，平均SWE没有显著差异。常规超声肠血管化评分鉴别重度炎症和轻/中度炎症的敏感性和特异性分别为87.5%和57.9%，AUC为0.811（P = 0.002）。结合SWE和常规超声（肠血管化评分），我们提出了肠狭窄的肠超声分类。超声分型与病理分型的一致性为中等（κ = 0.536，P<0.001）。
结论
这项初步研究表明，SWE在检测CD患者的肠纤维化方面是可行和准确的。经验证，结合SWE和肠道血管化的常规超声可能会被应用于指导治疗策略，在CD患者通过定义肠狭窄的类型。10.1093/ibd/izy115_video1izy115.video15777734754001。
Background and aim
The distinction of intestinal fibrosis from inflammation in Crohn's disease (CD) associated strictures has important therapeutic implications. Ultrasound elastography is useful in evaluating the degree of fibrosis in liver, but there is little evidence whether it can assess fibrosis in the bowel. We determined whether shear-wave elastography (SWE), a novel modification of elastography, quantifying tissue stiffness, could differentiate between inflammatory and fibrotic components in strictures of patients with CD.
Methods
Consecutive CD patients with ileal/ileocolonic strictures who underwent SWE within 1 week to surgical resection were enrolled. The SWE value of the stenotic bowel wall was compared to the grade and severity of fibrosis and inflammation, respectively, in the resected bowel specimen.
Results
Thirty-five patients were enrolled. The mean SWE value of stenotic bowel wall was significantly higher in severe fibrosis (23.0 ± 6.3 Kpa) than that in moderate (17.4 ± 3.8 Kpa) and mild fibrosis (14.4 ± 2.1 Kpa)(P = 0.008). Using 22.55 KPa as the cutoff value in discriminating between mild/moderate and severe fibrosis, the sensitivity and specificity was 69.6 % and 91.7% with an area under the curve (AUC) of 0.822 (P = 0.002). However, no significant difference regarding mean SWE existed among different grades of inflammation. The sensitivity and specificity of bowel vascularization score on conventional ultrasound in differentiating severe inflammation from mild/moderate was 87.5 % and 57.9% with AUC of 0.811 (P = 0.002). Combining SWE and conventional ultrasound (bowel vascularization score), we propose a bowel ultrasound classification of intestinal strictures. A moderate agreement between ultrasound and pathological classification was observed (κ = 0.536, P＜0.001).
Conclusions
This pilot study suggests that SWE is feasible and accurate in detecting intestinal fibrosis in patients with CD. After validation, combing SWE and bowel vascularization on conventional ultrasound might be applied to guide a management strategy in CD patients through defining the type of intestinal stricture. 10.1093/ibd/izy115_video1izy115.video15777734754001.
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