Accuracy of CT Enterography and Magnetic Resonance Enterography Imaging to Detect Lesions Preoperatively in Patients Undergoing Surgery for Crohn's Disease
Accuracy of CT Enterography and Magnetic Resonance Enterography Imaging to Detect Lesions Preoperatively in Patients Undergoing Surgery for Crohn's Disease
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DOI：
10.1097/dcr.0000000000000244
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发表时间：
2014-12-01
影响因子：
3.9
通讯作者：
Nandakumar, Govind
中科院分区：
文献类型：
--
作者：
Seastedt, Kenneth P.;Trencheva, Koiana;Nandakumar, Govind
背景技术背景：CT小肠造影和磁共振小肠造影已成为评价克罗恩病胃肠道的一线成像技术。目的：这项工作的目的是评价这些成像方式在术前识别克罗恩病病变的准确性。设计：这是一项回顾性图表回顾。设置：这项研究在一个单一的机构进行。患者：76例术前CT小肠造影和/或磁共振小肠造影的克罗恩病患者纳入本研究。主要观察指标：术前CT小肠造影和/或磁共振小肠造影显示的狭窄、瘘管和脓肿的数量与手术结果进行比较。40例患者（53%）为女性，46例（60%）因复发性克罗恩病接受手术，46例（57%）既往接受过腹部手术。36例（47%）术前进行了CT肠造影，43例（57%）术前进行了磁共振肠造影。CT小肠造影对狭窄的敏感性为75%，对瘘的敏感性为50%。MRE对狭窄的敏感性为68%，对瘘的敏感性为60%。CT小肠造影和磁共振小肠造影对狭窄的阴性预测值很低（54%和65%），对瘘的阴性预测值分别为85%和81%。CT小肠造影对狭窄的准确率为76%，对瘘的准确率为79%;磁共振小肠造影对狭窄的准确率为78%，对瘘的准确率为85%。两者均准确诊断脓肿。CT小肠造影的假阴性率为瘘50%，狭窄25%。磁共振小肠造影的假阴性率为瘘40%和狭窄32%。意外的术中发现导致修改计划的外科手术在20例（26%）。局限性：这项研究是有限的，其样本量小，其回顾性的性质，并在外部institutions.CONCLUSIONS：CT肠造影和磁共振肠造影在克罗恩病患者是准确的识别脓肿，但不是瘘或狭窄。外科医生应在术中寻找其他病变。应适当告知患者是否需要进行非预期干预（参见视频，补充数字内容1，http：//links.lww.com/DCR/A162）。
BACKGROUND: CT enterography and magnetic resonance enterography have emerged as first-line imaging technologies for the evaluation of the gastrointestinal tract in Crohn's disease.OBJECTIVE: The purpose of this work was to evaluate the accuracy of these imaging modalities to identify Crohn's disease lesions preoperatively.DESIGN: This was a retrospective chart review.SETTINGS: The study was conducted at a single institution.PATIENTS: Seventy-six patients with Crohn's disease with preoperative CT enterography and/or magnetic resonance enterography were included in the study.MAIN OUTCOME MEASURES: The number of stenoses, fistulas, and abscesses on CT enterography and/or magnetic resonance enterography before surgery were compared with operative findings.RESULTS: Forty patients (53%) were women, 46 (60%) underwent surgery for recurrent Crohn's disease, and 46 (57%) had previous abdominal surgery. Thirty-six (47%) had a preoperative CT enterography and 43 (57%) had a preoperative magnetic resonance enterography. CT enterography sensitivity was 75% for stenosis and 50% for fistula. MRE sensitivity was 68% for stenosis and 60% for fistula. The negative predictive values of CT enterography and magnetic resonance enterography for stenosis were very low (54% and 65%) and were 85% and 81% for fistula. CT enterography had 76% accuracy for stenosis and 79% for fistula; magnetic resonance enterography had 78% accuracy for stenosis and 85% for fistula. Both were accurate for abscess. False-negative rates for CT enterography were 50% for fistula and 25% for stenosis. False-negative rates for magnetic resonance enterography were 40% for fistula and 32% for stenosis. Unexpected intraoperative findings led to modification of the planned surgical procedure in 20 patients (26%).LIMITATIONS: This study was limited by its small sample size, its retrospective nature, and that some studies were performed at outside institutions.CONCLUSIONS: CT enterography and magnetic resonance enterography in patients with Crohn's disease were accurate for the identification of abscesses but not for fistulas or stenoses. Surgeons should search for additional lesions intraoperatively. Patients should be appropriately counseled regarding the need for unexpected interventions (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A162).