İnce bağırsak hastalıklarının değerlendirilmesinde MR enterografinin tanısal değeri

Öz

Amaç: Bu çalışmamızda kolay elde edilebilen ve iyi bir bağırsak distansiyonu sağlayan %3 mannitol ile manyetik rezonans (MR) enterografi yönteminin tanısal etkinliğinin değerlendirilmesini amaçlıyoruz.

Yöntemler: Yaşları 7-71 yıl arasında değişen 42 hasta çalışmaya dahil edildi. MR enterografi protokolü 1.5 Tesla MRG (Magnetom Aera; SiemensMedical Solutions, Erlangen, Germany) cihazı ile yapıldı. Bulgular cerrahi-fiberoptik kolonoskopiden elde edilen histopatolojik sonuçlarla karşılaştırıldı. Duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri, tanısal doğruluk oranı istatiksel olarak hesaplandı.

Bulgular: Duyarlılık %83, özgüllük %93, pozitif öngörü değeri %83, negatif öngörü değeri %93 ve tanısal doğruluk oranı %90 olarak saptanmıştır. Yalancı negatif olan iki hasta radyolojik olarak normal değerlendirildi, ancak patolojik inceleme nonspesifik inflamasyon olarak geldi. Yalancı pozitif olan bir hastada patolojik inceleme ülseratif kolit olarak, bir hastada ise invajinasyona neden olan ektopik pankreas dokusuna ait polipoid kitle saptandı. Gerçek pozitif olan dokuz hastada patoloji sonucu Crohn hastalığı, diğer hastada ise tipik olmamakla birlikte Crohn hastalığı lehine değerlendirildi. Ayrıca Crohn hastalığ ile takip edilen bir hastada iki yerde ince bağırsak segment tutulumu, diğer bir hastada da ileoileal fistül izlendi.

Sonuç: MR enterografi, Crohn hastalığının takibinde, hastalığın aktif sürecindeki inflamasyonun,  fibrostenoz evredeki striktürlerin, obstrüksiyonların, komplikasyonların belirlenmesinde ve tedavi seçeneğinin değerlendirilmesinde önemlidir. Gelecekte, mevcut MR sekansları ve yeni geliştirilen sekans teknikleriyle yapılacak geniş hasta katılımlı karşılaştırmalı çalışmalara ihtiyaç vardır. MR, ince bağırsağın diğer hastalıklarının değerlendirilmesinde de umut vericidir. 

Anahtar Kelimeler

• MR enterografi,Crohn hastalığı,mannitol

Diagnostic value of MR enterography for the assessment of small-bowel diseases

Abstract

Aim: We aim to evaluate the diagnostic efficiency of magnetic resonance (MR) enterography and mannitol %3 which have been gathered easily and provide good intestine distension.

Methods: 42 patients whose ages are between 7 and 71 have been included in the project. MR enterography protocol has been done by 1.5 Tesla MRG (Magnetom Aera, Siemens Medical Solutions, Erlangen, Germany) device. Findings were compared to histopathology results obtained by surgery and fiberoptic endoscopy. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy rate have been calculated statistically.

Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rate were calculated as 83%, 93%, 83%, 93% and 90%, respectively. Two patients with false negative results were evaluated as normal in the radiologic manner but pathologic investigation came as nonspecific inflammation. Pathologic investigation was recognized as ulcerative colitis for a patient with false positive result and in another patient with false positive result, invagination caused by a polypoid bulky mass due to the ectopic pancreas tissue was detected. Nine real positive patients were evaluated as having Crohn’s disease according to the pathologic investigation and other patient was evaluated as having Crohn’s disease though it was atypical. Additionally involvement of two small intestinal segments was seen for a patient with Crohn’s disease and ileoileal fistula was seen for another patient.

Conclusion: MR enterography is important for tracking of Crohn’s disease, inflammation in active process of the disease, strictures in fibro-stenotic phase, obstructions, determination of complications and evaluation of treatment options. There will be a need for comparative studies which have been done by current MR sequences and recently developing sequence techniques with inclusion of large number of patients. MR enterography is promising for evaluation of other diseases in the small intestine too.

Keywords

• MR enterography,Crohn disease,mannitol

Kaynakça

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