MR肠道成像及扫描前护理对克罗恩病肠道-泌尿道瘘的诊断价值

Value of MR enterography and pre-scanning nursing care for the characterization of enteric-urinary fistula in Crohn’s disease

目的探讨MR肠道成像(MRE)及扫描前护理对克罗恩病(CD)肠道-泌尿道瘘的诊断价值。方法回顾性收集22例行手术治疗并有术前MRE扫描的CD肠道-泌尿道瘘患者临床资料。在MRE图上观察肠道-泌尿道瘘的位置和形态,并在电子病例系统上查阅患者的扫描前护理、扫描方案及手术记录。以术中所见的肠道-泌尿道瘘情况为金标准,分析MRE诊断肠道-泌尿道瘘的优劣势以及扫描前护理工作对其诊断的影响。结果 22例患者中,MRE诊断为肠道-膀胱瘘者16例和肠道-输尿管瘘者5例,手术诊断为肠道-膀胱瘘者18例和肠道-输尿管瘘者15例。MRE诊断肠道-膀胱瘘的准确性较高(AUC=0.944;P=0.006),但诊断肠道-输尿管瘘的准确性较低(AUC=0.667;P=0.217)。未接受标准扫描前护理的患者MRE诊断肠道-泌尿道瘘的准确性(0/5)远低于接受标准扫描前护理者(12/17)(P=0.010)。结论 MRE对肠道-膀胱瘘具有较高的诊断价值,但是难以准确诊断肠道-输尿管瘘;标准的MRE扫描前护理可改善图片质量而提高诊断准确率。

Objective To evaluate the diagnostic value of MR enterography(MRE) and prescanning nursing care for the characterization of enteric-urinary fistula in Crohn’s disease(CD). Methods The preoperative MRE of 22 CD patients with enteric-urinary fistulas who underwent surgery were retrospectively analyzed. The location and morphology of the enteric-urinary fistulas were observed on MRE, and the pre-scan nursing care, scan protocol and surgical records were reviewed on the electronic medical record. Using the intraoperative findings of enteric-urinary fistulas as reference standard, the strengths and weaknesses of MRE and the influence of pre-scan nursing care for diagnosing enteric-urinary fistulas were respectively analyzed. Results Of 22 patients, 16 had enteric-bladder fistulas and 5 had enteric-ureteral fistulas on MRE, while 18 had enteric-bladder fistulas and 15 had enteric-ureteral fistulas in surgery. The accuracy of MRE was high for the detection of enteric-bladder fistulas(AUC=0.944, P=0.006) but low for enteric-ureteral fistulas(AUC=0.667, P=0.217). The accuracy of MRE in the patients who did not receive standard pre-scan nursing care(0/5) is significantly lower than those who received standard prescan nursing care(12/17)(P=0.010). Conclusion The diagnostic value of MRE is high for the entericbladder fistulas but low for the enteric-ureteral fistula. A standard pre-scan nursing care can improve diagnostic accuracy by enhancing the MR images quality.