CT小肠造影对活动性克罗恩病的诊断价值  

The value of diagnosis of active Crohn disease with CT enterography

作　　者：高旭宁[1] 许茂盛[1] 卢良骥[1] 丁国苗[1] 王世威[1] 

机构地区：[1]浙江中医药大学附属第一医院放射科,浙江杭州310006

出　　处：《医学影像学杂志》2011年第3期377-380,共4页Journal of Medical Imaging

摘　　要：目的：本研究的目的是确定CT小肠造影（CT enterography,CTE）检查对活动性克罗恩病诊断价值。方法：回顾性分析58例确诊克罗恩病患者。男性47例,女性11例,平均年龄53.5岁。所有病例行小肠CTE检查。扫描范围从膈顶至盆腔。由2位不知道病理结果的放射科医生共同观察确定有无病变,病灶部位,累积肠段数目,肠壁厚度,肠壁强化,肠腔狭窄,肠外淋巴结,肠系膜水肿及血管改变,肠外炎症,瘘管及瘘道等,判断病变是否具有活动性。并将CTE检查结果与临床症状及内镜检查比较。结果：58例克罗恩病以回肠末端为最常见受累部位（54/58）,小肠单独受累（48/58）,小肠-结肠受累（10/58）。肠壁增厚（51/58）。累积肠段数目（107段）、肠壁厚度（3.2~21.5）mm,动脉期肠壁强化（56.2~89.4）HU静脉期（87.6~103.8）HU、肠腔狭窄（55/58）、肠外淋巴结（32/58）、肠系膜水肿及血管改变（50/58）、肠外炎症、瘘管及瘘道等（3/58）。临床症状及内镜检查证实的活动期患者51例,稳定期患者7例。2位医生诊断活动性克罗恩病阳性48例,3例稳定期病例误认为活动期。CTE诊断克罗恩病活动期的敏感度、特异度、阳性预测值及阴性预测值分别为（94%,48/51）、（40%,2/5）、（96%,48/50）、（38%,3/8）。结论：CT小肠造影对活动期克罗恩病诊断具有较高的价值,确诊还应结合临床及肠镜检查。CT小肠造影对早期克罗恩病诊断作用还有待研究。Objective：The purpose of our study was to determine the value of diagnosis of active Crohn disease（CD） with CT enterography（CTE）.Methods：In 58 patients（11 women,47 men;mean age,53.5 years） with known Crohn disease were retrospectively evaluated.All patients underwent CT enterography examination,scanning filed including abdomen and pelvis.two radiologists who were unknow the clinical history blinded interpreted imagings.They determined whether imaging findings of Crohn disease were present,lesion site,number,thickness of intestinal wall,types of intestinal wall thickening,stenosis of enteric cavity,CT attenuations of intestinal wall,complications and adjacent organs involvement,and whether the findings actived,or remained stable.CT enterography findings were then compared with clinical symptoms and endoscopy was performed.Results：In 58 patients terminal ileum is most frequently involved in CD（54/58）,lesions located in small bowel alone were（48/58）,small bowel-colon（10/58）.Bowel wall thickening（51/58）,implicated intestinal segment（107 segments）,thickness of the intestines（3.2～21.5） mm,enteric phase attenuations of intestinal wall（87.6～103.8） HU,bowel stenosis（55/58）,mesenteric lymph nodes（32/58）,the mesenteric edema and mesenteric vascular change（50/58）,parenteral inflammation,fistula（3/58）.51 active Crohn disease cases were conformed by clinical symptoms and endoscopy,clinically stable disease were 7 cases.48 activity CD cases were diagnosed by two doctors,3 cases were error diagnosis.The diagnosis activity CD sensitivity,specificity,positive predictive value and negative predictive value for two readers with CTE were（94%,48/51）,（40%,2/5）,（96%,48/50）,（38%,3/8） respectively.Conclusion：CTE proved to have higher value in diagnosis activity CD.Mading diagnosis shoud be combine clinical symptoms and endoscopy examination.CTE was not a good choice in diagnose early stage of Crohns disease.

关 键 词：克罗恩病 CT小肠造影 体层摄影术 X线计算机 

分 类 号：R574[医药卫生—消化系统] R814.42[医药卫生—内科学]