AIM To examine the correlation between magnetic resonance imaging(MRI) and endoscopic index of severity(CDEIS) in patients with Crohn's disease(CD).METHODS This was a retrospective study of 104 patients with CD th...AIM To examine the correlation between magnetic resonance imaging(MRI) and endoscopic index of severity(CDEIS) in patients with Crohn's disease(CD).METHODS This was a retrospective study of 104 patients with CD that were treated at the Ruijin Hospital between March 2015 and May 2016. Among them, 61 patients with active CD were evaluated before/after treatment. MRI and endoscopy were performed within 7 d. CDEIS was evaluated. MRI parameters included Ma RIA scores, total relative contrast enhancement(tRCE), arterialRCE(aRCE), portalRCE(pRCE), delay phaseRCE(dRCE), and apparent diffusion coefficient. The correlation and concordance between multiple MRI findings and CDEIS changes before and after CD treatment were examined.RESULTS Among the 104 patients, 61 patients were classified as active CD and 43 patients as inactive CD. Gender, age, disease duration, and disease location were not significantly different between the two groups(all P > 0.05). CRP levels were higher in the active group than in the inactive group(25.12 ± 4.12 vs 5.14 ± 0.98 mg/L, P < 0.001). Before treatment, the correlations between CDEIS and MaRIAs in all patients were r = 0.772 for tRCE, r = 0.754 for aRCE, r = 0.738 for pRCE, and r = 0.712 for dRCE(all MaRIAs, P < 0.001), followed by MRI single indexes. Among the active CD patients, 44 cases were remitted to inactive CD after treatment. The correlations between CDEIS and MaRIAs were r = 0.712 for aRCE, r = 0.705 for tRCE, r = 0.685 for pRCE, and r = 0.634 for dRCE(all MaRIAs, P < 0.001).CONCLUSION Arterial Ma RIA should be an indicator for CD follow-up and dynamic assessment. CD treatment assessment was not completely concordant between CDEIS and MRI.展开更多
AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who ...AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.展开更多
The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activ...The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activity and treatment response, and discrimination of inflammatory from fibrotic strictures. IBD is a chronic idiopathic disease affecting the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn's disease and ulcerative colitis. The paper discusses, in detail the pros and cons of the different IBD imaging modalities that need to be considered in order to optimize the imaging and clinical evaluation of patients with IBD. Historically, IBD evaluation of the bowel has included imaging to assess the portions of the small bowel that are inaccessible to optical endoscopic visualization. This traditionally was performed using barium fluoroscopic techniques; however, cross-sectional imaging techniques(computed tomography and magnetic resonance imaging) are being increasingly utilized for IBD evaluation because they can simultaneously assess mural and extramural IBD manifestations. Recent advances in imaging technology, that continue to improve the ability of imaging to noninvasively follow disease activity and treatment response, are also discussed. This review article summarizes the current imaging approach in inflammatory bowel disease as well as the role of emerging imaging modalities.展开更多
Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recogniti...Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection.展开更多
BACKGROUND The individual performances and the complementarity of Crohn's disease(CD)activity index(CDAI), C-reactive protein(CRP) and faecal calprotectin(Fcal) to monitor patients with CD remain poorly inves-tiga...BACKGROUND The individual performances and the complementarity of Crohn's disease(CD)activity index(CDAI), C-reactive protein(CRP) and faecal calprotectin(Fcal) to monitor patients with CD remain poorly inves-tigated in the era of "tight control"and "treat to target" strategies.AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk(W12) of anti-tumor necrosis factor(TNF) therapy to predict corticosteroids-free remission(CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP >2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.RESULTS Among the 40 included patients, 13 patients(32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12(P = 0.012), CRP level < 2.9 mg/L at W12(P = 0.001) and Fcal improvement at W12(Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal(< 100 μg/g)(P = 0.001) were predictive of CFREM at W52. Combined endpoint(CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0%(100.0-100.0)and negative predictive value = 87.1%(75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio(OR) = 45.1(2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3(0.36-237.1); P = 0.145]and CRP < 2.9 mg/L(0.77-278.0; P = 0.073).CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.展开更多
Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big ...Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain(LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-toapply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intraarticular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.展开更多
BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over time.An image-based index,the Lémann index(LI),has been developed to measure cumulative BD.AIM To ch...BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over time.An image-based index,the Lémann index(LI),has been developed to measure cumulative BD.AIM To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term progression.METHODS This was a single-center longitudinal cohort study.Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were reevaluated after 5-12 years.RESULTS Seventy-two patients were included.LI increased in 38 patients(52.8%),remained unchanged in 9 patients(12.5%),and decreased in 25 patients(34.7%).The small bowel score and surgery subscale significantly increased(P=0.002 and P=0.001,respectively),whereas the fistulizing subscale significantly decreased(P=0.001).Baseline parameters associated with BD progression were ileal location(P=0.026),CD phenotype[stricturing,fistulizing,or both(P=0.007,P=0.006,and P=0.035,respectively)],disease duration>10 years(P=0.019),and baseline LI stricturing score(P=0.049).No correlation was observed between BD progression and baseline clinical activity,biological markers,or severity of endoscopic lesions.CONCLUSION BD,as assessed by the LI,progressed in half of the patients with CD over a period of 5-12 years.The main determinants of BD progression were ileal location,stricturing/fistulizing phenotype,and disease duration.展开更多
文摘AIM To examine the correlation between magnetic resonance imaging(MRI) and endoscopic index of severity(CDEIS) in patients with Crohn's disease(CD).METHODS This was a retrospective study of 104 patients with CD that were treated at the Ruijin Hospital between March 2015 and May 2016. Among them, 61 patients with active CD were evaluated before/after treatment. MRI and endoscopy were performed within 7 d. CDEIS was evaluated. MRI parameters included Ma RIA scores, total relative contrast enhancement(tRCE), arterialRCE(aRCE), portalRCE(pRCE), delay phaseRCE(dRCE), and apparent diffusion coefficient. The correlation and concordance between multiple MRI findings and CDEIS changes before and after CD treatment were examined.RESULTS Among the 104 patients, 61 patients were classified as active CD and 43 patients as inactive CD. Gender, age, disease duration, and disease location were not significantly different between the two groups(all P > 0.05). CRP levels were higher in the active group than in the inactive group(25.12 ± 4.12 vs 5.14 ± 0.98 mg/L, P < 0.001). Before treatment, the correlations between CDEIS and MaRIAs in all patients were r = 0.772 for tRCE, r = 0.754 for aRCE, r = 0.738 for pRCE, and r = 0.712 for dRCE(all MaRIAs, P < 0.001), followed by MRI single indexes. Among the active CD patients, 44 cases were remitted to inactive CD after treatment. The correlations between CDEIS and MaRIAs were r = 0.712 for aRCE, r = 0.705 for tRCE, r = 0.685 for pRCE, and r = 0.634 for dRCE(all MaRIAs, P < 0.001).CONCLUSION Arterial Ma RIA should be an indicator for CD follow-up and dynamic assessment. CD treatment assessment was not completely concordant between CDEIS and MRI.
文摘AIM To assess magnetic resonance imaging(MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn's disease(CD).METHODS From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo(5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence(POR) was defined as Rutgeerts' index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.RESULTS Apparent diffusion coefficient(ADC) was lower in patients with endoscopic POR compared to those with no recurrence(2.03 ± 0.32 vs 2.27 ± 0.38 × 10^(-3) mm^2/s, P = 0.032). Clermont score(10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement(RCE)(129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity(Ma RIA)(7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system(P = 0.056). ADC < 2.35 × 10^(-3) mm^2/s [sensitivity = 0.85, specificity = 0.65, positive predictive value(PPV) = 0.85, negative predictive value(NPV) = 0.65] and RCE > 100%(sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cutoff values to identify endoscopic POR. Clermont score > 6.4(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), Ma RIA > 3.76(sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1(sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR(114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR(sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).CONCLUSION Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.
文摘The purpose of this paper is to evaluate the role of imaging in inflammatory bowel disease(IBD), including detection of extraluminal complications and extraintestinal manifestations of IBD, assessment of disease activity and treatment response, and discrimination of inflammatory from fibrotic strictures. IBD is a chronic idiopathic disease affecting the gastrointestinal tract that is comprised of two separate, but related intestinal disorders; Crohn's disease and ulcerative colitis. The paper discusses, in detail the pros and cons of the different IBD imaging modalities that need to be considered in order to optimize the imaging and clinical evaluation of patients with IBD. Historically, IBD evaluation of the bowel has included imaging to assess the portions of the small bowel that are inaccessible to optical endoscopic visualization. This traditionally was performed using barium fluoroscopic techniques; however, cross-sectional imaging techniques(computed tomography and magnetic resonance imaging) are being increasingly utilized for IBD evaluation because they can simultaneously assess mural and extramural IBD manifestations. Recent advances in imaging technology, that continue to improve the ability of imaging to noninvasively follow disease activity and treatment response, are also discussed. This review article summarizes the current imaging approach in inflammatory bowel disease as well as the role of emerging imaging modalities.
文摘Gastrointestinal luminal endoscopy is of paramount importance for diagnosis, monitoring and dysplasia surveillance in patients with both, Crohn's disease and ulcerative colitis. Moreover, with the recent recognition that mucosal healing is directly linked to the clinical outcome of patients with inflammatory bowel disorders, a growing demand exists for the precise, timely and detailed endoscopic assessment of superficial mucosal layer. Further, the novel field of molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapeutic responses. Within this review, we describe how novel endoscopic approaches and advanced endoscopic imaging methods such as high definition and high magnification endoscopy, dye-based and dye-less chromoendoscopy, confocal laser endomicroscopy, endocytoscopy and molecular imaging now allow for the precise and ultrastructural assessment of mucosal inflammation and describe the potential of these techniques for dysplasia detection.
文摘BACKGROUND The individual performances and the complementarity of Crohn's disease(CD)activity index(CDAI), C-reactive protein(CRP) and faecal calprotectin(Fcal) to monitor patients with CD remain poorly inves-tigated in the era of "tight control"and "treat to target" strategies.AIM To assess CDAI, CRP and Fcal variation, alone or combined, after 12 wk(W12) of anti-tumor necrosis factor(TNF) therapy to predict corticosteroids-free remission(CFREM = CDAI < 150, CRP < 2.9 mg/L and Fcal < 250 μg/g with no therapeutic intensification and no surgery) at W52.METHODS CD adult patients needing anti-TNF therapy with CDAI > 150 and either CRP >2.9 mg/L or Fcal > 250 μg/g were prospectively enrolled.RESULTS Among the 40 included patients, 13 patients(32.5%) achieved CFREM at W52. In univariable analysis, CDAI < 150 at W12(P = 0.012), CRP level < 2.9 mg/L at W12(P = 0.001) and Fcal improvement at W12(Fcal < 300 μg/g; or, for patients with initial Fcal < 300 μg/g, at least 50% decrease of Fcal or normalization of Fcal(< 100 μg/g)(P = 0.001) were predictive of CFREM at W52. Combined endpoint(CDAI < 150 and CRP ≤ 2.9 mg/L and FCal improvement) at W12 was the best predictor of CFREM at W52 with positive predictive value = 100.0%(100.0-100.0)and negative predictive value = 87.1%(75.3-98.9). In multivariable analysis, Fcal improvement at W12 [odd ratio(OR) = 45.1(2.96-687.9); P = 0.03] was a better predictor of CFREM at W52 than CDAI < 150 [OR = 9.3(0.36-237.1); P = 0.145]and CRP < 2.9 mg/L(0.77-278.0; P = 0.073).CONCLUSION The combined monitoring of CDAI, CRP and Fcal after anti-TNF induction therapy is able to predict favorable outcome within one year in patients with CD.
文摘Intervertebral disc degeneration and facet joint osteoarthritis of the lumbar spine are, among others, wellknown as a cause of low back and lower extremity pain. Together with their secondary disorders they set a big burden on health care systems and economics worldwide. Despite modern imaging modalities, such as magnetic resonance imaging, for a large proportion of patients with low back pain(LBP) it remains difficult to provide a specific diagnosis. The fact that nearly all the lumbar structures are possible sources of LBP, may serve as a possible explanation. Furthermore, our clinical experience confirms, that imaging alone is not a sufficient approach explaining LBP. Here, the Oswestry Disability Index, as the most commonly used measure to quantify disability for LBP, may serve as an easy-toapply questionnaire to evaluate the patient's ability to cope with everyday life. For therapeutic purposes, among the different options, the lumbar facet joint intraarticular injection of corticosteroids in combination with an anaesthetic solution is one of the most frequently performed interventional procedures. Although widely used the clinical benefit of intra-articular steroid injections remains controversial. Therefore, prior to therapy, standardized diagnostic algorithms for an accurate assessment, classification and correlation of degenerative changes of the lumbar spine are needed.
基金Supported by the Helmsley Charitable Trust Grant,No.2015PG-IBD005.
文摘BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disorder that progresses to bowel damage(BD)over time.An image-based index,the Lémann index(LI),has been developed to measure cumulative BD.AIM To characterize the long-term progression of BD in CD based on changes in the LI and to determine risk factors for long-term progression.METHODS This was a single-center longitudinal cohort study.Patients who had participated in prospective studies on the accuracy of magnetic resonance imaging using endoscopy as a gold standard and who had a follow-up of at least 5 years were reevaluated after 5-12 years.RESULTS Seventy-two patients were included.LI increased in 38 patients(52.8%),remained unchanged in 9 patients(12.5%),and decreased in 25 patients(34.7%).The small bowel score and surgery subscale significantly increased(P=0.002 and P=0.001,respectively),whereas the fistulizing subscale significantly decreased(P=0.001).Baseline parameters associated with BD progression were ileal location(P=0.026),CD phenotype[stricturing,fistulizing,or both(P=0.007,P=0.006,and P=0.035,respectively)],disease duration>10 years(P=0.019),and baseline LI stricturing score(P=0.049).No correlation was observed between BD progression and baseline clinical activity,biological markers,or severity of endoscopic lesions.CONCLUSION BD,as assessed by the LI,progressed in half of the patients with CD over a period of 5-12 years.The main determinants of BD progression were ileal location,stricturing/fistulizing phenotype,and disease duration.
