Zusammenfassung
Die aktualisierte Deutsche S 3-Leitline „Diagnostik und Therapie des Morbus Crohn” beinhaltet zahlreiche Neuerungen bezüglich radiologischer Techniken und Methoden bei Patienten mit Morbus Crohn. In dem Artikel fokussieren wir auf radiologische Methoden zur Diagnose des Morbus Crohn, wobei wir besonders die relevanten Unterschiede zur älteren Deutschen und Europäischen Leitlinie herausarbeiten. Zusätzlich diskutieren wir die neue Leitlinie im Kontext der neuesten radiologischen Literatur zu diesem Thema.
Abstract
The recently updated German S 3-guideline regarding the diagnosis and treatment of Crohn’s disease incorporates several changes concerning the radiological approach compared to the former guideline. This article focuses on guideline-based radiological imaging techniques for patients with Crohn’s disease. The new guideline is also compared to former European and German guidelines in the context of recently published radiological literature.
Key words
abdomen - inflammation - small bowel - guideline
Literatur
1
Hoffmann J C, Preiss J C, Autschbach F. et al .
S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn”.
Z Gastroenterol.
2008;
46
1094-1146
2
Stange E F, Schreiber S, Folsch U R. et al .
Diagnostik und Therapie des M. Crohn – Ergebnisse einer evidenzbasierten Konsensuskonferenz der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten.
Z Gastroenterol.
2003;
41
19-20
3
Stange E F, Travis S P, Vermeire S. et al .
European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis.
Gut.
2006;
55
i1-i15
4
Travis S P, Stange E F, Lemann M. et al .
European evidence based consensus on the diagnosis and management of Crohn’s disease: current management.
Gut.
2006;
55
i16-i35
5
Pascu M, Roznowski A B, Muller H P. et al .
Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel.
Inflammatory bowel diseases.
2004;
10
373-382
6
Parente F, Greco S, Molteni M. et al .
Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel.
Aliment Pharmacol Ther.
2003;
18
1009-1016
7
Beall D P, Fortman B J, Lawler B C. et al .
Imaging bowel obstruction: a comparison between fast magnetic resonance imaging and helical computed tomography.
Clinical radiology.
2002;
57
719-724
8
Biancone L, Fiori R, Tosti C. et al .
Virtual colonoscopy compared with conventional colonoscopy for stricturing postoperative recurrence in Crohn’s disease.
Inflammatory bowel diseases.
2003;
9
343-350
9
Rogalla P, Janka R, Baum U. et al .
CT-Kolografie: Leitlinie der Arbeitsgemeinschaft Gastrointestinale Diagnostik der Deutschen Röntgengesellschaft zur Indikation und technischen Durchfürhung der endoluminalen Dickdarmdiagnostik mittels Computertomografie (sog. virtuelle Koloskopie).
Röntgenstr Fortschr.
2008;
180
466-469
10
Taylor S A, Laghi A, Lefere P. et al .
European Society of Gastrointestinal and Abdominal Radiology (ESGAR): consensus statement on CT colonography.
Eur Radiol.
2007;
17
575-579
11
Bremner A R, Pridgeon J, Fairhurst J. et al .
Ultrasound scanning may reduce the need for barium radiology in the assessment of small-bowel Crohn’s disease.
Acta Paediatr.
2004;
93
479-481
12
Laghi A, Borrelli O, Paolantonio P. et al .
Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn’s disease.
Gut.
2003;
52
393-397
13
Darbari A, Sena L, Argani P. et al .
Gadolinium-enhanced magnetic resonance imaging: a useful radiological tool in diagnosing pediatric IBD.
Inflammatory bowel diseases.
2004;
10
67-72
14
Hohl C, Honnef D, Krombach G. et al .
MRT des Darms bei Kindern – beschleunigte Bildgebung in einem Atemzug.
Röntgenstr Fortschr.
2008;
180
402-409
15
Muirhead C R, O’Hagan J A, Haylock R G. et al .
Mortality and cancer incidence following occupational radiation exposure: third analysis of the National Registry for Radiation Workers.
Br J Cancer.
2009;
100
206-212
16
Sodickson A, Baeyens P F, Andriole K P. et al .
Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults.
Radiology.
2009;
251
175-184
17
Desmond A N, O’Regan K, Curran C. et al .
Crohn’s disease: factors associated with exposure to high levels of diagnostic radiation.
Gut.
2008;
57
1524-1529
18
Bozkurt T, Richter F, Lux G.
Ultrasonography as a primary diagnostic tool in patients with inflammatory disease and tumors of the small intestine and large bowel.
J Clin Ultrasound.
1994;
22
85-91
19
Sheridan M B, Nicholson D A, Martin D F.
Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn’s disease or recurrence: a prospective study.
Clinical radiology.
1993;
48
402-404
20
Parente F, Greco S, Molteni M. et al .
Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy.
Gut.
2004;
53
1652-1657
21
Horsthuis K, Bipat S, Bennink R J. et al .
Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies.
Radiology.
2008;
247
64-79
22
Schreyer A G, Geissler A, Albrich H. et al .
Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn’s disease.
Clin Gastroenterol Hepatol.
2004;
2
491-497
23
Wold P B, Fletcher J G, Johnson C D. et al .
Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy – feasibility study.
Radiology.
2003;
229
275-281
24
Masselli G, Casciani E, Polettini E. et al .
Comparison of MR enteroclysis with MR enterography and conventional enteroclysis in patients with Crohn’s disease.
Eur Radiol.
2008;
18
438-447
25
Lee S S, Kim A Y, Yang S K. et al .
Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel follow-through as diagnostic techniques.
Radiology.
2009;
251
751-761
26
Albert J G, Martiny F, Krummenerl A. et al .
Diagnosis of small bowel Crohn’s disease: a prospective comparison of capsule endoscopy with magnetic resonance imaging and fluoroscopic enteroclysis.
Gut.
2005;
54
1721-1727
27
Golder S K, Schreyer A G, Endlicher E. et al .
Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease.
Int J Colorectal Dis.
2006;
21
97-104
28
Voderholzer W A, Beinhoelzl J, Rogalla P. et al .
Small bowel involvement in Crohn’s disease: a prospective comparison of wireless capsule endoscopy and computed tomography enteroclysis.
Gut.
2005;
54
369-373
29
Liangpunsakul S, Chadalawada V, Rex D K. et al .
Wireless capsule endoscopy detects small bowel ulcers in patients with normal results from state of the art enteroclysis.
The American journal of gastroenterology.
2003;
98
1295-1298
30
Eliakim R, Fischer D, Suissa A. et al .
Wireless capsule video endoscopy is a superior diagnostic tool in comparison to barium follow-through and computerized tomography in patients with suspected Crohn’s disease.
Eur J Gastroenterol Hepatol.
2003;
15
363-367
31
Triester S L, Leighton J A, Leontiadis G I. et al .
A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn’s disease.
The American journal of gastroenterology.
2006;
101
954-964
32
Goldstein J L, Eisen G M, Lewis B. et al .
Video capsule endoscopy to prospectively assess small bowel injury with celecoxib, naproxen plus omeprazole, and placebo.
Clin Gastroenterol Hepatol.
2005;
3
133-141
33
Graham D Y, Opekun A R, Willingham F F. et al .
Visible small-intestinal mucosal injury in chronic NSAID users.
Clin Gastroenterol Hepatol.
2005;
3
55-59
34
Maconi G, Sampietro G M, Parente F. et al .
Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study.
The American journal of gastroenterology.
2003;
98
1545-1555
35
Schmidt T, Hohl C, Haage P. et al .
Phase-inversion tissue harmonic imaging compared to fundamental B-mode ultrasound in the evaluation of the pathology of large and small bowel.
Eur Radiol.
2005;
15
2021-2030
36
Potthast S, Rieber A, Von Tirpitz C. et al .
Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison.
Eur Radiol.
2002;
12
1416-1422
37
Schwartz D A, White C M, Wise P E. et al .
Use of endoscopic ultrasound to guide combination medical and surgical therapy for patients with Crohn’s perianal fistulas.
Inflammatory bowel diseases.
2005;
11
727-732
38
Wedemeyer J, Kirchhoff T, Manns M P. et al .
Transcutaneous perianal ultrasound (PAUS) for the imaging of fistulas and abscesses in Crohn’s disease.
Zeitschrift für Gastroenterologie.
2004;
42
1315-1320
39
Stewart L K, McGee J, Wilson S R.
Transperineal and transvaginal sonography of perianal inflammatory disease.
AJR.
2001;
177
627-632
40
Parks A G, Gordon P H, Hardcastle J D.
A classification of fistula-in-ano.
Br J Surg.
1976;
63
1-12
41
Thornton M, Solomon M J.
Long-term indwelling seton for complex anal fistulas in Crohn’s disease.
Dis Colon Rectum.
2005;
48
459-463
42
Rasul I, Wilson S R, MacRae H. et al .
Clinical and radiological responses after infliximab treatment for perianal fistulizing Crohn’s disease.
The American journal of gastroenterology.
2004;
99
82-88
PD Dr. Andreas G. Schreyer, MBA
Institut für Röntgendiagnostik, Universitätsklinikum Regensburg
Franz-Josef-Strauss-Allee 11
93051 Regensburg
Phone: ++ 49/9 41/9 44 74 01
Fax: ++ 49/9 41/9 44 74 02
Email: andreas.schreyer@klinik.uni-regensburg.de