MR imaging evaluation of the activity of Crohn's disease
MR imaging evaluation of the activity of Crohn's disease
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DOI：
10.2214/ajr.177.6.1771325
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发表时间：
2001-12-01
影响因子：
5
通讯作者：
Healy, JC
中科院分区：
文献类型：
--
作者：
Koh, DM;Miao, Y;Healy, JC
客观的。本研究的目的是评估 MR 成像评估克罗恩病活动性的敏感性和特异性。 对象和方法：使用 MR 成像对 30 名有症状但疾病活动性不确定的克罗恩病患者进行前瞻性检查。使用克罗恩病活动指数对 29 名患者进行评分。成像前口服 600 毫升水，肌内注射 1 毫克胰高血糖素。使用 T2 加权涡轮自旋回波、T1 加权快速低角度拍摄和脂肪抑制钆增强 T1 加权快速低角度拍摄序列获得屏气图像。图像由两名放射科医生评估，他们不知道患者的症状、临床评分和其他影像学检查，但他们对影像学结果（肠壁增厚、肠壁增强和肠周变化）达成共识，并确定每位患者是否存在活动性疾病。磁共振成像结果与内窥镜检查和手术相关。结果。 23 名患者患有活动性疾病，7 名患者患有非活动性疾病。通过 MR 成像和内窥镜检查或手术对总共 168 个肠段中的 124 个进行了检查。以每位患者为基础，MR 成像对活动性疾病的总体敏感性为 91%，特异性为 71%。克罗恩病活动指数的敏感性为 92%，特异性为 28%。以每个节段为基础，MR 成像的敏感性为 59%，特异性为 93%。肠壁增厚大于 4 毫米、肠壁增强（异常肠与正常肠的信号强度之比 > 1.3:1）以及肠系膜血管分布增加有助于识别活动性疾病。静脉注射钆后的分层增强模式对于活动性炎症具有高度特异性。结论。磁共振成像可用于评估克罗恩病的活动性，并且在临床评分不明确时可能会有所帮助。
OBJECTIVE. The purpose of this study was to evaluate the sensitivity and specificity of MR imaging in assessing the activity of Crohn's disease.SUBJECTS AND METHODS: Thirty symptomatic patients with Crohn's disease but uncertain disease activity were prospectively examined using MR imaging. Twenty-nine patients were scored using the Crohn's disease activity index. Six hundred milliliters of water orally and 1 mg of glucagon intramuscularly were given before imaging. Breath-hold images were obtained using T2-weighted turbo spin-echo, T1-weighted fast low-angle shot, and fat-suppressed gadolinium-enhanced T1-weighted fast low-angle shot sequences. Images were assessed by two radiologists who were unaware of the patient's symptoms, clinical scoring, and other imaging tests, and who reached a consensus about the imaging findings (bowel wall thickening, bowel wall enhancement, and perienteric changes) and determined the absence or presence of active disease in each patient. MR imaging findings were correlated with endoscopy and surgery.RESULTS. Twenty-three patients had active disease and seven patients had inactive disease. One hundred twenty-four of a total of 168 bowel segments were examined with both MR imaging and endoscopy or surgery. On a per patient basis, MR imaging had an overall sensitivity of 91% and a specificity of 71% for active disease. The Crohn's disease activity index had a sensitivity of 92% and a specificity of 28%. On a per segment basis, MR imaging had a sensitivity of 59% and a specificity of 93%. Bowel wall thickening of greater than 4 mm, bowel wall enhancement (ratio of signals intensity of abnormal to normal bowel > 1.3:1), and increased mesenteric vascularity were useful in identifying active disease. A layered enhancement pattern after the IV administration of gadolinium was highly specific for active inflammation.CONCLUSION. MR imaging is useful in assessing the activity of Crohn's disease and may be helpful when clinical scoring is equivocal.