Ultrazvuk i magnetno rezonantna enterografija u dijagnostici Kronove bolesti u dečjem uzrastu
Sažetak
Sažetak
Uvod
Kronova bolest je hronična inflamatorna bolest creva, čiji tok karakterišu remisije i relapsi, a koja se najčešće javlja u mlađoj populaciji. MR enterografija (MRE) i UZ nastoje da preuzmu glavnu ulogu u dijagnostici, inicijalnoj proceni Kronove bolesti, praćenju njene aktivnosti i u detekciji i proceni komplikacija.
Cilj rada
Ispitati SE, SP, PPV, NPV UZ i MRE u dijagnostici Kronove bolesti, kao i ukupnu dijagnostičku vrednost MRE poređenjem morfoloških i funkcionalnih parametara sa nalazima ileokolonskopije i patohistologije.
Materijal i metode
40 pacijenata praćeno je od kraja 2009. do kraja 2016. godine. MRE i UZ su pregledani pacijenti upućeni zbog kliničkih i laboratorijskih nalaza, a koji su imali potvrđenu dijagnozu na endoskopiji/patohistologiji. UZ su evaluirani debljina zida creva, edem mezenterijuma i uvećanje mezenterijalnih limfnih čvorova. Pored ovih parametara, MRE su evaluirani i postkontrastno pojačanje intenziteta signala i znak “stratifikacije”.
Rezultati
Sveukupna dijagnostička vrednost morfoloških i funkcionalnih parametara na MRE ima SE 58.3% i SP 100% u slučaju da potvrđujemo dijagnozu, i SE 87.5% i SP 80% u slučaju da isključujemo dijagnozu. Pokazana je statistički značajna korelacija između zadebljanja zida i nagomilavanja masnog tkiva u mezenterijumu na MRE, i zlatnog standarda.
Korelacija UZ i MRE rezultata pokazuje visoku statističku značajnost u ileumu, terminalnom ileumu, Bauhinievoj valvuli i cekumu, kao i u ascedentnom kolonu. Pokazana je visoka specifičnost (SP) obe dijagnostičke procedure u gotovo svim segmentima (maksimalno 94,7%). Senzitivnost (SE) se kretala od 0 do čak 83,3% u pojedinim delovima creva.
Zaključak
Naša studija je pokazala da je pouzdano koristiti MRE i UZ u otklanjanju sumnje na Kronovu bolest. Takođe, kombinacija funkcionalnih i morfoloških parametara na MRE pokazali su se korisnim u postavljanju dijagnoze Kronove bolesti i praćenju ove dece.
Ključne reči: Kronova bolest, deca, magnetno rezonantna enterografija, ultrazvuk
Reference
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