Sequenz-Evaluation für die MR-Enterografie für Patienten mit Morbus Crohn

Zusammenfassung

Ziel: Evaluation eines Routine-MRT-Protokolls für die MR-Enterografie (MRE) zur Untersuchung von Patienten mit Morbus Crohn (MC), um ein subjektives Ranking bezüglich wichtiger und weniger wichtiger Sequenzen zur Entscheidungsfindung hinsichtlich einer Diagnose zu erhalten.

Material und Methoden: 84 Patienten (42 männlich) mit histologisch gesichertem MC wurden prospektiv mit einer koronaren T2 / T1-gewichteten-Sequenz (TrueFISP), einer axialen T2-gewichteten Turbo-Spin-Echo-Sequenz (HASTE), einer axialen T1-gewichteten Gradienten-Echo-Sequenz (2D-FLASH) sowie axialen und koronaren kontrastmittelverstärkten 2D-FLASH-Sequenzen untersucht. Die Sequenzen wurden von 4 erfahrenen Radiologen unabhängig voneinander subjektiv mit einer Schulnotenskala (1 = sehr gut; 5 = unbrauchbar) bezüglich ihrer Wichtigkeit in der Diagnosefindung und Bildbeurteilung benotet. Die sich aus der Benotung ergebende Rangfolge der MRT-Sequenzen wurde mit der Rangvarianz-Analyse nach Friedman auf ihre Signifikanz überprüft.

Ergebnisse: Es ergibt sich folgendes Ranking: HASTE vor kontrastmittelverstärkter 2D-FLASH koronar, vor TrueFISP und vor der kontrastmittelverstärkten 2D-FLASH axial, zuletzt die 2D-FLASH nativ. Der Unterschied zwischen der erstplatzierten HASTE und der zweitplatzierten kontrastmittelverstärkten 2D-FLASH-Sequenz koronar war signifikant (p < 0,05), die weiteren Ergebnisse (p < 0,01) hochsignifikant.

Schlussfolgerung: Die nativen, stabilen und schnell durchführbaren MRT-Sequenzen einer koronaren TrueFISP und einer axialen HASTE wurden subjektiv als Platz 1 und 3 im Ranking eingestuft. Das Untersuchungsprotokoll bei der MRE bei MC-Patienten sollte mit kontrastgestützten T1-gewichteten Gradienten-Echo-Sequenzen vor allem in koronarer Schichtführung ergänzt werden, ggf. mit einer Erweiterung auch in axialer Orientierung, wobei auf native T1-gewichtete Sequenzen verzichtet werden kann.

Abstract

Purpose: To evaluate a routine MR enterography (MRE) protocol for patients with Crohn’s disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions.

Materials and Methods: We prospectively examined 84 patients (42 male) with known CD using a coronal T2 / T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after intravenous contrast application. 4 experienced radiologists subjectively evaluated the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic decision. The ranking of the different sequences was statistically tested by the Friedman analysis.

Results: The following ranking was found: HASTE sequences were ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLASH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01).

Conclusion: The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted.

Key words

abdomen - MR imaging - efficacy studies

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