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Bowel ultrasound in assessment of Crohns disease and detection of related small bowel strictures: a prospective comparative study versus x ray and intraoperative findings

机译：肠超声检查对克罗恩病的评估和相关小肠狭窄的检测：与X射线和术中发现的前瞻性比较研究

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Background and aim: Despite the fact that bowel ultrasound (US) has recently been proved to be useful in the assessment of bowel diseases, uncertainty persists as to its diagnostic role in patients with complicated Crohn's disease (CD). Therefore, we have prospectively investigated the accuracy of US compared with x ray procedures and intraoperative findings in detecting small bowel strictures complicating CD as well as its reliability in assessing disease extent and location within the bowel.Methods: A series of 296 consecutive patients with proven CD admitted to L Sacco University Hospital between 1997 and 1999, having undergone complete radiographic evaluation (including small bowel x ray, colonoscopy, or double contrast barium enema), were enrolled in the study. Bowel US was performed in each patient by two experienced operators unaware of the results of other diagnostic procedures. The accuracy of US in detecting strictures compared with x ray studies was determined separately in two different groups of patients: 211 patients treated conservatively (non-operative CD) and 85 patients who were candidates for surgery for CD complications or unresponsiveness to medical therapy (operative CD).Results: Overall sensitivity and specificity of US in assessing the anatomical distribution of CD were 93% and 97%, respectively. The extent of ileal disease measured at US correlated well with that determined by x ray (r=0.52, p<0.001) in medically treated patients as well as with that measured intraoperatively in surgical patients (r=0.64, p<0.001). One or more stenoses were detected in 75 patients (35.5%) at small bowel enteroclysis in the non-operative CD group compared with 70 (82%) in the operative CD series. Sensitivity, specificity, and positive predictive values of bowel US in the detection of strictures were 79%, 98%, and 95% in non-operative CD patients and 90%, 100%, and 100% in operative CD cases, respectively.Conclusions: In experienced hands, bowel US is an accurate technique for assessing CD extent and location and is very helpful in detecting small bowel strictures, especially in very severe cases that are candidates for surgery. The use of bowel US is therefore justified as a primary investigation in CD patients in whom complications are suspected.
机译：背景与目的：尽管最近已证明肠道超声（US）可用于评估肠道疾病，但其在复杂克罗恩病（CD）患者中的诊断作用仍存在不确定性。因此，我们前瞻性地研究了US与X线检查相比较的准确性以及术中发现的发现小肠狭窄并发CD的准确性，以及其在评估肠内疾病范围和位置方面的可靠性。方法：一系列296例经证实的连续患者在1997年至1999年之间，接受了X光检查（包括小肠X射线，结肠镜检查或双对比钡灌肠）的L萨科大学医院住院的CD纳入了研究。两名经验丰富的操作员对每位患者进行了Bowel US检查，他们并不知道其他诊断程序的结果。在两个不同的患者组中分别确定了US与X射线检查相比检测狭窄的准确性：保守治疗的211例患者（非手术CD）和CD并发症或对药物治疗无反应的候选患者85例（手术）结果：美国在评估CD解剖分布方面的总体敏感性和特异性分别为93％和97％。在US上测得的回肠疾病程度与x射线确定的药物治疗患者以及手术中术中测量的疾病的相关性（r = 0.52，p <0.001）（r = 0.64，p <0.001）。非手术CD组在小肠小肠肠溶菌检查中发现75例患者（35.5％）有一种或多种狭窄，而手术CD系列中有70例（82％）。在非手术CD患者中，肠US检测狭窄的敏感性，特异性和阳性预测值分别为79％，98％和95％，在手术CD患者中分别为90％，100％和100％。 ：对于经验丰富的人，肠US是评估CD程度和位置的准确技术，对检测小肠狭窄非常有帮助，特别是在非常严重的情况下，适合进行手术的患者。因此，在怀疑有并发症的CD患者中，使用US肠是合理的主要研究方法。

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