多层螺旋CT小肠造影对Crohn病的诊断价值评价  

Assessment of the diagnostic value of multi-slice CT enterography in patients with Crohn's disease

作　　者：朱希松[1] 章士正[2] 毛明香[1] 

机构地区：[1]浙江省衢州市人民医院放射科,浙江衢州324000 [2]浙江大学医学院附属邵逸夫医院放射科,浙江杭州310016

出　　处：《医学影像学杂志》2011年第6期860-865,共6页Journal of Medical Imaging

摘　　要：目的:探讨多层螺旋CT小肠造影对Crohn病的诊断价值。方法:回顾性分析经内镜、手术、病理证实的60例Crohn病的多层螺旋CT小肠造影影像学表现。结果:60例中多节段病变43例(72%),单独小肠受累21例(35%)、小肠和大肠同时受累35例(58%)、单独大肠受累4例(7%)。小肠累及的56例(93%)中,累及回肠末端39例(70%)。MSCTE所见包括:肠壁增厚60例(100%)、强化增加58例(97%)、肠壁分层39例(65%)、肠腔狭窄32例(53%)、肠壁脓肿5例(8%)、肠系膜血管增多("梳征")39例(65%)、病变肠管周围纤维脂肪增多19例(32%)、蜂窝织炎40例(67%)、腹腔脓肿和炎性肿块13例(22%)、窦道/瘘管15例(25%)、假憩室12例(20%)、多发淋巴结肿42例(70%)、肛周病变4例(7%)。肠管增厚、肠管分层、强化增加、肠壁内脓肿、病变肠管周围蜂窝织炎、血管增多(梳征)等可反应病变的活动性。动脉期与静脉期比较,未提供肠壁、肠管外病变的更多信息。结论:CT小肠造影可同时显示Crohn病的小肠和结肠病变,对肠壁病变及肠腔外并发症的显示以及在判断病变活动性方面有独特的优越性,可作为首选的影像学检查方法。Objective：To investigate the value of multi-slice CT enterography（MSCTE） in the diagnosis of Crohn＇s disease.Methods：60 patients with histologically proven Crohn＇s disease underwent MSCTE.Imaging findings were analyzed retrospectively.Results：Among the 60 cases,there were 43 cases（72%） of skip lesions.21 cases（35%） had lesions limited to the small intestine,the small intestine and the colon were involved simultaneously in 35 cases（58%）,only 4 cases（7%） had lesions limited to the colon.Among 56 cases（93%） which had small intestinal lesions,the terminal ileum was involved in 39 cases（70%）.The findings of those patients on MSCTE were 60 cases（100%） of bowel wall thickening,58 cases（97%） of mural hyperenhancement,39 cases（65%） of mural stratification,32 cases（53%） of stenosis,5 cases（8%） of mural abscess,39 cases（65%） of increased mesenteric vascularity（comb sign）,19 cases（32%） of fibrofatty proliferation,40 cases（67%） of phlegmon,13 cases（22%） of abscesses or inflammatory masses,15 cases（25%） of fistulas/sinus tracts,12 cases（20%） of pseudosacculations,42cases（70%） of mesenteric lymphadenopathy,4 cases of perianal lesion.CT findings of bowel wall thickening,mural stratification,mural hyperenhancement,mural abscess,perienteric phlegmon,and comb sign correlated with active inflammation.Compared with venous phase imaging,arterial phase imaging was noncontributory in all cases.Conclusion：MSCTE can demonstrate lesions of the small intestine and the colon simultaneously,and it proved to have advantages in depicting mural abnormalities and evaluating extramural abnormalities and activity of Crohns disease.MCSTE should be the imaging method of first choice when Crohns disease is suspected.

关 键 词：肠疾病 CROHN病 小肠造影术 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]