3.0T核磁共振扫描对克罗恩病活动性评估的诊断价值  

3.0T MRI for assessment of disease activity in Crohn′s disease

作　　者：朱炯[1] 许建荣[1] 朱震亚[1] 龚红霞[1] 钟喨[1] 

机构地区：[1]上海交通大学医学院附属仁济医院放射科,200127

出　　处：《现代消化及介入诊疗》2010年第4期199-204,217,共7页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的研究3.0TMR影像对评估克罗恩病患者疾病活动性的价值。材料与方法本次研究包括确诊为克罗恩病的36名患者,运用3.0TMR影像资料评估患者病变的分期。基于肠壁异常增厚、肠壁异常强化、肠腔狭窄、"木梳征"、肠系膜增大的淋巴结、瘘道、溃疡及脓肿7个基本征象,制定出MR影像诊断标准。以临床诊断为金标准进行比较。结果本次研究共评估了216组肠段,其中发现76组肠段有异常。受累及肠段的平均厚度为(3.24±0.92)mm。增强后脂肪抑制T1WI显示异常强化肠段62段。7名患者发现肠段狭窄及狭窄后扩张(7/36);20名患者发现"木梳征"(20/36);9名患者发现肠系膜淋巴结肿大(直径>10mm)(9/36);2名患者发现溃疡(2/36);4名患者发现瘘道(4/36);所有的患者中未发现脓肿。3.0TMR影像评估活动性克罗恩病的敏感度为68.0%,特异度为90.9%,阳性预测值为94.4%,阴性预测值为55.6%,Kappa值为0.500。结论 3.0TMR影像学诊断能有效地鉴别活动期和缓解期克罗恩病,与临床诊断之间相关性分析的Kappa值为0.500,提示有较好相关性。Purpose To investigate the diagnostic value of 3.0T MRI for evaluating the disease activity of Crohn′s disease.Materials and methods Thirty-six patients were examined with a 3.0T MR system to evaluate the activity of Crohn′s disease compared with clinical diagnosis based on the manifestations such as wall thickening,increased enhancement,stenosis,＂comb sign,＂enlarged lymph node,fistula,ulceration,and abscess.Clinical diagnosis is the＂gold standard.＂Results A total of 76 abnormal bowel segments were detected from 216 segments with 3.0T MRI.The mean bowel wall measured with 3.0T MRI of 76 abnormal segments was（3.24±0.92）mm.On the T1-weighted fat-saturated images,62 of 76 abnormal segments on 3.0T MR manifested obvious enhancement.Stenosis with prestenotic dilatation was seen in 7 of 36 patients.＂Comb sign＂was evident in 20 of 36 patients.Enlarged mesenteric lymph node（short axis10 mm）was seen in 9 of 36 patients.Ulceration was detected in 2 of 36 patients.Fistula was detected in 4 of 36 patients.Abscess was not seen on all 36 cases.Sensitivity of 3.0T MR for the depiction of the activity of Crohn′s disease was 68.0%,specificity was 90.9%,positive predictive value was 94.4%,negative predictive value was 55.6%（kappa= 0.500）.Conclusion 3.0T MRI is effective in differentiating active and remissive Crohn′s disease.The correlation between 3.0T evaluation and clinical diagnosis is strong.

关 键 词：克罗恩病 活动期 3.0T核磁共振 

分 类 号：R574.620.2[医药卫生—消化系统]