Bildgebende Primärdiagnostik und Verlaufsbeurteilung bei chronisch-entzündlichen Darmerkrankungen

Abstract

The objective of this study is to assess the value of imaging techniques in primary diagnostics and development of chronic inflammatory bowel disease in pediatric patients. It examines the extent to which less invasive imaging methods (such as MRI and Ultrasound) are able to replace methods associated with radiation exposure and operation in routine diagnostics. This retrospective survey is an analysis of the imaging methods of examination administered to 59 children and youth with chronic inflammatory bowel disease, that were conducted between 2005 and 2011 in the Pediatric Radiology Department at the University of Gießen. Endoscopy including histology was considered the gold standard, as it is in the majority of international surveys. Initially (1.) the sensitivity and specify of imagery methods in 7 different bowl segments were identified, than (2.) values of the imagery methods through comparative measures were investigated. In conclusion (3.) ultrasound was reviewed, including doppler ultrasound, in terms of its utilization for analysis of the disease. This was done by comparing different ultrasound parameters with severity levels of the disease in the endoscopic findings, clinical and laboratory parameters.Out of 59 patients, the following examinations have been effected between 2005 and 2011: 464 abdominal ultrasound (US), 44 MRI, 81 Endoscopic examinations including histology, 29 positron emission topographies with computer tomography (PET-CT), 4 Computertomographies (CT) and 6 X-Ray examinations (RÖ). 1. The following sensitivities and specifies have been identified: US: Sens.:0,938 [0,938; 0,997], MRT Sens.: 0,759 [0,645; 0,873] and Spec.: 0,45 [0,232; 0,668], PET-CT Sens.: 0,875 [0,799; 0,951] Spec.: 0,563 [0,319; 0,806]. For CT no sensitivity nor specify had been calculated due to the insufficient number of only CT reports. 2. The comparison of the imagery methods exhibits an agreement in the detection of the bowel wall changes. The data shows: between US and MRI the similarity was 83%, PET-CT and US 89%, US and CT 84%, however between RÖ and US the concurrence was only 50%. Between CT and MRT 82% of the cases matched, and again PET-CT and MRT showed an 82% match. 3. There was a significant correlation between bowel wall thickness in mm measured by ultrasound and severity in endoscopy (including histology) (P=0,044). We were able to partially correlate between the c- reactive protein (CRP), the erythrocyte sedimentation rate (ESR) and the Calprotectin value in stool and the intestinal wall thickness, peritoneal reaction and a present hyperperfusion in doppler ultrasound. There was no significant correlation between the ultrasound parameters and various clinical parameters such as diarrhea or abdominal pain. Due to the excellent sensitivity of US and MRI and the high percentage of coherence to those imagery methods with PET-CT and CT in our survey, methods that inflict radiation should be omitted in routine diagnostics, especially in pediatrics. Due to missing negative reports of the bowel segment, it was difficult to confirm specificity of imagery methods within our survey. Therefore the detected values for specifics cannot be considered as very meaningful in our survey. In our survey ultrasound, especially the measured bowel wall thickness shows a coherence with the severity grade found in endoscopy and with laboratory inflammation parameters. The gentle nature, easy availability, and the progressive enhancement of the technology are, besides proving great results, also justifies to employ ultrasound as a standard imagery method in diagnostics and evaluation of chronic inflammatory bowel diseases. However, as ultrasound often lacks a complete insight of the abdomen, and a successful procedure of MRI in children is more difficult than the fast procedure of CT, for detection of virulent complications like bowel perforation, radiographic procedures should be implemented in those cases.