经皮肛周超声与盆腔磁共振评估克罗恩病肛周病变的一致性研究  

The consistency of transcutaneous perianai ultrasonography and pelvic magnetic resonance in assessing perianal lessons of Crohn＇s disease

作　　者：冉志华[1] 钱孝先[1] 沈骏[1] 黄美兰[1] 王天蓉[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科上海市消化疾病研究所,200001

出　　处：《中华消化杂志》2011年第9期582-586,共5页Chinese Journal of Digestion

基　　金：国家自然科学基金资助项目（81000161）;上海交通大学医学院附属仁济医院学科建设资助项目（RJ4101305）;上海交通大学医学院科技基金资助项目（YZ1036）

摘　　要：目的分析经皮肛周超声（transcutaneous perianal ultrasonography，TPUS）与盆腔磁共振（magnetic resonance imaging，MRI）诊断克罗恩病肛周病变的一致性，评价TPUS诊断克罗恩病肛周病变的价值。方法连续性纳入2008年8月至2010年8月期间确诊为克罗恩病的患者102例，采用超声及MRI系统分别诊断克罗恩病患者肛周脓肿和瘘管的情况。应用统计软件SPSS11．5进行χ^2检验，以Kappa检验进行一致性分析。结果克罗恩病肛周病变的起病时间平均为典型症状出现的-0．443年（95％CI：-1．659～0．773年）。使用TPUS和盆腔MRI诊断肛周病变无显著的统计学差异（P=0．706，Kappa=0．541）。如以盆腔MRI作为诊断肝周脓肿和瘘管的金标准，则得出TPUS诊断诊断肛周病变的灵敏度为72．73％，特异度为82．61％，Youden指数为0．55，阳性预测值为66．67％，阴性预测值为86．36％。TPUs和盆腔MRI诊断肛周脓肿（P=0．706，Kappa=0．496）及肛周瘘管（P=0．655，Kappa=0．546）差异均无统计学意义。结论肛周病变可以出现在克罗恩病发病的整个病程中，利用TPUS诊断克罗恩病的肛周脓肿和瘘管与盆腔MRI相比具有良好的一致性，TPUS可作为诊断及评估克罗恩病的肛周病变的辅助方法。Objective To analyze the consistency of transcutaneous perianal ultrasonography （TPUS） and pelvic magnetic resonance imaging （MR1） in diagnosing perianal lesions of Crohn＇s disease （CD）, and to evaluate the value of transcutaneous perianal ultrasonography in detecting perianal lesions of CD. Methods A cohort of 102 patients diagnosed as Corhn＇s disease were enrolled from August 2008 to August 2010. Perianal abscess and fistula of these CD patients was diagnosed by uhrasonography and MRI system. Statistics was performed with SPSS 11.5 software for χ^2 test. The consistency was analyzed with Kappa test. Results The mean onset time of perianal lesions in CD was -0. 443 year （95 %CI：- 1. 659-0. 773 year） before typical symptoms showed up. There was no significant difference in detecting perianal lesions of CD between transcutaneous perianal ultrasonography and pelvic magnetic resonance imaging （P= 0. 706, Kappa=0. 541）. If pelvic magnetic resonance imaging was considered as the golden standard in detecting perianal lesions of CD, the sensitivity （Sen）, specificity （Spe）, Youden＇s index, positive predictive value （PPV） and negative predictive value （NPV） of TPUS were 72. 735%, 82.61 %. 0.55. 66.67% and 86.36% respeclively. Furthermore, there was no significant difference between transcutaneous perianal ultrasonography and pelvic magnetic resonance imaging in detecting perianal abscess （P=0. 706, Kappa=0. 496） and fistula （P=0. 655, Kappa=0. 546） of CD. Conclusions Perianal lesions occur in the entire course of CD. There was favorable consistency between transcutaneous perianal ultrasonography and pelvic magnetic resonance imaging in detecting perianal abscess and fistula of CD. Transcutaneous perianal ultrasonography can be used as an additional method in detecting and evaluting perianal lesions of CD.

关 键 词：超声检查 克罗恩病 肛门疾病 脓肿 直肠瘘 磁共振成像 骨盆 

分 类 号：R445.1[医药卫生—影像医学与核医学]