İnce bağırsak hastalıklarının değerlendirilmesinde MR enterografinin tanısal değeri

Yıl 2017, Cilt: 2 Sayı: 2, 39 - 44, 15.08.2017

İlgar Allahverdiyev Mustafa Koplay Hasan Erdogan Emine Uysal Hüseyin Korkmaz Halil haldun Emiroglu

https://doi.org/10.25000/acem.321322

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

Öz

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.

Anahtar Kelimeler

MR enterography, Crohn disease, mannitol

Kaynakça

• 1. Amzallag-Bellenger E, Oudjit A, Ruiz A, Cadiot G, Soyer PA, Hoeffel CC. Effectiveness of MR enterography for the assessment of small-bowel diseases beyond Crohn disease. Radiographics 2012;32(5):1423-44.
• 2. Kavaliauskiene G, Ziech ML, Nio CY, Stoker J. Small bowel MRI in adult patients: not just Crohn's disease-a tutorial. Insights Imaging. 2011 Oct;2(5):501-13.
• 3. Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics 2009;29(6):1811-25.
• 4. Frokjaer JB, Larsen E, Steffensen E, Nielsen AH, Drewes AM. Magnetic resonance imaging of the small bowel in Crohn's disease. Scand J Gastroenterol. 2005;40(7):832-42.
• 5. Schmidt S, Lepori D, Meuwly JY, Duvoisin B, Meuli R, Michetti P, Felley C, Schnyder P, van Melle G, Denys A. Prospective comparison of MR enteroclysis with multidetector spiral-CT enteroclysis: interobserver agreement and sensitivity by means of "sign-by-sign" correlation. Eur Radiol 2003;13(6):1303-11.
• 6. Aerts P, Van Hoe L, Bosmans H, Oyen R, Marchal G, Baert AL. Breath-hold MR urography using the HASTE technique. AJR Am J Roentgenol. 1996 Mar;166(3):543-5.
• 7. Ha HK, Lee EH, Lim CH, Shin YM, Jeong YK, Yoon KH, Lee MG, Min YI, Auh YH. Application of MRI for small intestinal diseases. J Magn Reson Imaging. 1998 Mar-Apr;8(2):375-83.
• 8. Miyazaki T, Yamashita Y, Tsuchigame T, Yamamoto H, Urata J, Takahashi M. MR cholangiopancreatography using HASTE (half-Fourier acquisition single-shot turbo spin echo) sequences. AJR Am J Roentgenol 1996; 166:1297-303.
• 9. Lin MF, Narra V. Developing Role of Magnetic Resonance Imaging in Crohn's Disease. Curr Opin Gastroenterol 2008;24(2):135-140.
• 10. Gourtsoyiannis NC, Papanikolaou N, Karantanas A. Magnetic resonance imaging evaluation of small intestinal Crohn’s disease. Best Pract Res Clin Gastroenterol 2006;20:137-156.
• 11. Gourtsoyiannis N, Papanikolaou N, Grammatikakis J, MR Imaging of the Small Bowel with a True-FISP Sequence After Enteroclysis with Water Solution. Invest Radiol 2000;35:707-711.
• 12. Waleed A, Susanne G, Hubert S, Stefan R, Jorg D, Thomas L. Oral contrast agentsfor small bowel MRI: comparison of different additives to optimize bowel distension. Eur Radiol 2004;14:458-464.
• 13. Herborn CU, Vogt F, Lauenstein TC, Goyen M, Debatin JF, Ruehm SG. MRI of the liver: can True FISP replace HASTE? J Magn Reson Imaging. 2003 Feb;17(2):190-6.
• 14. Korman U, Kurugoglu S, Ogut G. Conventional enteroclysis with complementary MR enteroclysis: a combination of small bowel imaging. Abdom Imaging. 2005 Sep-Oct;30(5):564-75.
• 15. Albert JG, Martiny F, Krummenerl A, Stock K, Lesske J, Göbel CM, Lotterer E, Nietsch HH, Behrmann C, Fleig WE. Diagnosis of small bowel Crohn's disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis. Gut. 2005 Dec;54(12):1721-7.
• 16. Gölder SK, Schreyer AG, Endlicher E, Feuerbach S, Schölmerich J, Kullmann F, Seitz J, Rogler G, Herfarth H. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis. 2006 Mar;21(2):97-104.
• 17. Cheifetz AS, Kornbluth AA, Legnani P, Schmelkin I, Brown A, Lichtiger S, Lewis BS. The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease. Am J Gastroenterol. 2006 Oct;101(10):2218-22.
• 18. Rollandi GA, Curone PF, Biscaldi E, Nardi F, Bonifacino E, Conzi R, Derchi LE. Spiral CT of the abdomen after distention of small bowel loops with transparent enema in patients with Crohn's disease. Abdom Imaging. 1999 Nov-Dec;24(6):544-9.
• 19. Romano S, De Lutio E, Rollandi GA, Romano L, Grassi R, Maglinte DD. Multidetector computed tomography enteroclysis (MDCT-E) with neutral enteral and IV contrast enhancement in tumor detection. Eur Radiol. 2005 Jun;15(6):1178-83.
• 20. Jaffe TA, Gaca AM, Delaney S, Yoshizumi TT, Toncheva G, Nguyen G, Frush DP. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. AJR Am J Roentgenol. 2007 Nov;189(5):1015-22.
• 21. Low RN, Francis IR, Politoske D, Bennett M. Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging. 2000 Feb;11(2):127-35.
• 22. Leyendecker JR, Bloomfeld RS, DiSantis DJ, Waters GS, Mott R, Bechtold RE. MR enterography in the management of patients with Crohn disease. Radiographics. 2009 Oct;29(6):1827-46.
• 23. Mazziotti S, Ascenti G, Scribano E, Gaeta M, Pandolfo A, Bombaci F, Donato R, Fries W, Blandino A. Guide to magnetic resonance in Crohn's disease: from common findings to the more rare complicances. Inflamm Bowel Dis. 2011May;17(5):1209-22.
• 24. Maccioni F. Introduction to the feature section on "Crohn's disease activity: MRI assessment and clinical implications". Abdom Imaging. 2012;37(6):917-20.
• 25. Gallego Ojea JC, Echarri Piudo AI, Porta Vila A. Crohn's disease: the usefulness of MR enterography in the detection of recurrence after surgery. Radiologia. 2011 Nov-Dec;53(6):552-9.
• 26. Kitazume Y, Satoh S, Hosoi H, Noguchi O, Shibuya H. Cine magnetic resonance imaging evaluation of peristalsis of small bowel with longitudinal ulcer in Crohn disease: preliminary results. J Comput Assist Tomogr. 2007 Nov-Dec;31(6):876-83.
• 27. Udayasankar UK, Martin D, Lauenstein T, Rutherford R, Galloway J, Tudorascu D, Sitaraman SV. Role of spectral presaturation attenuated inversion-recovery fat-suppressed T2-weighted MR imaging in active inflammatory bowel disease. J Magn Reson Imaging 2008;28(5):1133-40.
• 28. Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, Ha HK. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques. Radiology 2009 ;251(3):751-61.
• 29. Siddiki HA, Fidler JL, Fletcher JG, Burton SS, Huprich JE, Hough DM, Johnson CD, Bruining DH, Loftus EV Jr, Sandborn WJ, Pardi DS, Mandrekar JN. Prospective comparison of state-of-the-art MR enterography and CT enterography in small-bowel Crohn's disease. AJR Am J Roentgenol 2009;193(1):113-21.
• 30. Bourreille A et all. World Organisation of Digestive Endoscopy (OMED) and the European Crohn's and Colitis Organisation (ECCO). Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED-ECCO consensus. Endoscopy. 2009;41(7):618-37.
• 31. Potthast S, Rieber A, Von Tirpitz C, Wruk D, Adler G, Brambs HJ. Ultrasound and magnetic resonance imaging in Crohn's disease: a comparison. Eur Radiol 2002; 12(6):1416-22.
• 32. Schreyer AG, Menzel C, Friedrich C, Poschenrieder F, Egger L, Dornia C, Schill G, Dendl LM, Schacherer D, Girlich C, Jung EM. Comparison of high-resolution ultrasound and MR-enterography in patients with inflammatory bowel disease. World J Gastroenterol 2011: 28;17(8):1018-25.