Comparison Of CTE With MRE And US In Diagnostic Value Of Small Bowel Crohn's Disease: Meta-analysis

Objective:Crohn's disease(CD)is a type of chronic inflammatory granulomatous disease involved in entire digestive tract,whose morbidity in China is gradually increasing.Computed tomography enterography(CTE),magnetic resonance enterography(MRE)and abdomen ultrasound(US)have played an increasingly important role in diagnosing CD,detecting activity and complications.Meta-analysis was used for comparing the diagnostic value of CTE with MRE and US for small bowel CD.Methods:Databases were systematically searched for relevant articles on the diagnosis of CD using CTE,MRE or US by inclusion and exclusion criteria.QUADAS was used for assessing the quality of the literatures.Whether there was a threshold effect was determined by means of Spearman correlation analysis and summary receiver operating characteristic curve(sROC).The data were pooled to yield summary sensitivity,specificity and the area under the SROC curve(AUC).Then CTE was compared with MRE and US in diagnostic efficacy and detectability of activity and complications.Results : The pooled sensitivity,specificity,DOR of CTE was81%(95%CI,78%-85%),82%(95%CI,77%-86%),16.67(95%CI,11.30-24.60),and of MRE was88%(95%CI,83%-91%),90%(95%CI,86%-94%),40.58(95%CI,12.08-136.35),and of US was94%(95%CI,91%-97%),97%(95%CI,95%-98%),329.68(95%CI,148.49-731.99).The results of Z-test revealed that there was no statistically significant difference in diagnostic performance between CTE and MRE(Z=1.65,P > 0.05),but US had higher diagnostic performance than CTE(Z=6.85,P < 0.05).There was no statistically significant difference between CTE and MRE in detecting CD complications such as stenosis(P=0.55),fistula(P=0.97)and abscess(P=0.78),and in detecting activity(P=0.29).There was no statistically significant difference between CTE and US in detecting CD complications such as stenosis(P=0.46),fistula(P=0.54),abscess(P=0.28)and proximal narrow dilation(P=0.35).Conclusions:CTE,MRE and US have excellent diagnostic performance for CD.There is no significant difference in diagnostic efficacy between CTE and MRE,but US has higherdiagnostic efficacy than CTE.There is no significant difference between CTE and MRE in detection abilities of activity and complications such as stenosis,fistula and abscess.There is no significant difference between CTE and US in detection abilities of complications such as stenosis,fistula,abscess and proximal narrow dilation.Even though US has high diagnostic value in CD,more rational designed large sample studies are still needed for further evaluation.