背景:肛周瘘对克罗恩病(CD)患者构成双重挑战。由于现有检查方法的复杂性,患者依从性低,困扰着肛周CD的治疗和随访管理。
目的:确定肛门内超声(EUS)和剪切波弹性成像(SWE)评估肛周吻合性CD(PFCD)活动的准确性。
方法:这是一项回顾性队列研究。从2022年8月至2023年12月,共诊断为CD的67例患者分为三组:非肛瘘组(n=23)。低活动性肛周瘘[n=19,肛周疾病活动指数(PDAI)≤4],基于PDAI的高活动性肛周瘘(n=25,PDAI>4)。所有患者均接受评估,包括EUS+SWE,骨盆磁共振[骨盆磁共振成像(MRI)],C反应蛋白,粪便钙卫蛋白,CD活动指数,PDAI。
结果:骨盆MRI和EUS显示的瘘的百分比一致为82%,肛周瘘的分类具有良好的一致性(Kappa=0.752,P<0.001)。两组血流Limberg评分(χ2=8.903,P<0.05)和剪切波速度(t=2.467,P<0.05)差异有统计学意义。剪切波速度与CD(Magnifi-CD)评分中瘘管成像的磁共振新指标呈强负相关(r=-0.676,P<0.001),与PDAI评分呈弱负相关(r=-0.386,P<0.05),Limberg评分与PDAI评分之间存在弱相关性(r=0.368,P<0.05)。
结论:EUS联合SWE为检测和定量CD患者肛周瘘的活动提供了一种优越的方法。它可能是管理战略客观评估PFCD活动的理想工具。
BACKGROUND: Perianal fistulas pose dual challenges to Crohn\'s disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.
OBJECTIVE: To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity.
METHODS: This was a retrospective cohort
study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI.
RESULTS: The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ 2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05).
CONCLUSIONS: EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.