CT小肠成像对克罗恩病活动性分级定量评估的价值  

Quantitative study on grading activity of Crohn disease with CT enterography

作　　者：程静云 谢辉[1] 杨昊[1] 王科[1] 徐国斌[1] 吴光耀[1] Cheng Jingyun;Xie Hui;Yang Hao;Wang Ke;Xu Guobin;Wu Guangyao(Department of Radiology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院医学影像中心,430071

出　　处：《中华放射学杂志》2018年第8期608-613,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金重大仪器专项（81171315）;国家重点研发专项（2016YFC1304702）

摘　　要：目的 探讨CT小肠成像（CTE）对克罗恩病（CD）活动性定量评估的可行性和价值.方法 回顾性分析2016年4月至2017年6月武汉大学中南医院经临床、小肠镜、病理及影像等诊断为CD的49例患者.患者均行常规小肠镜及CTE标准化检查,2种检查时间间隔小于2周,且在间隔期进行红细胞沉降率（ESR）及C反应蛋白（CRP）水平检测.ESR为2.0～97.0 mm/1 h,平均（30.6±26.5）mm/1 h;CRP为0.3～143.3 mg/L,中位数为27.7 mg/L.小肠镜检查根据克罗恩病简化内镜活动性评分（SES-CD）将CD患者分为非活动组、轻微活动组及中重度活动组.CTE检查评价病变部位、病变最严重处的肠壁厚度及肠壁强化模式、门静脉期黏膜强化CT值及强化差值,有无肠腔狭窄、肠周炎症、肠系膜血管增粗（梳征）、增大淋巴结、腹腔脓肿、瘘管等.采用χ2检验比较不同CD患者组间肠壁强化模式的差异,采用方差分析比较不同CD患者组间肠壁厚度、平扫CT值、门静脉期黏膜强化CT值、ΔCT值的差异采用Pearson（正态分布数据）或Spearman（偏态分布数据）评价CTE指标与小肠镜评分及实验室检查结果的相关性.结果 SES-CD为1～15分,平均（5.1±2.6）分,其中非活动组13例、轻微活动组19例、中重度活动组17例.49例中,有肠道梗阻或狭窄25例,其中活动组24例,非活动组1例,差异有统计学意义（χ2=13.3,P〈0.01）;7例淋巴结短径超过10 mm,全部为活动组患者;32例肠系膜血管增粗、增多,表现为＂梳征＂,其中活动组28例,非活动组4例,差异有统计学意义（χ2=9.3,P〈0.01）;30例病变部位肠管表现为肠周炎症,其中活动组27例,非活动组3例,差异有统计学意义（χ2=10.8,P〈0.01）;1例肠系膜间脓肿及2例肠壁间内瘘均为活动组患者.非活动组的肠壁强化模式主要以C、D型为主,而活动组的肠壁强化模式主要以A、B型为主,差异有统计学意义（P〈0.05）;不同组间患者的肠Objective To explore the feasibility and the value of CT enterography （CTE） in the quantitative evaluation of Crohn＇s disease （CD）. Methods Retrospeetively analyzed 49 patients diagnosed as CD by clinical, enteroscopy, pathology, and imaging from April 2016 to June 2017 in Zhongnan Hospital of Wuhan University. All patients underwent routine enteroscopy and standardized CTE. The interval between the two examinations was less than 2 weeks. Erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） levels were measured at intervals. The ESR ranged from 2.0 to 97.0 ram/1 h, with an average of （30.6＋26.5） ram/1 h, CRP from 0.3 to 143.3 mg/L, and a median of 27.7 mg/L. CD patients were classified into inactive, mild and moderate-severe according to Crohn＇s disease simplified endoscopic activity score（SES-CD） after enteroscopy. CTE evaluated the site of lesion, the thickness and enhanced patterns of the most severe lesions of the bowel wall, mural enhanced CT value in the portal vein phase, ACT value, stenosis, perienteric inflammation, mesenteric hypervascularity （comb sign）, enlarged lymph nodes, abdominal abscesses, fistulas, etc. The Chi-square test was used to compare the differences of enhanced patterns among different groups. ANOVA （Analysis of Variance） was used to compare the differences in bowel wall thickness, plain CT values, mural enhanced CT value in the portal vein phase and ACT values among different groups. The correlation between CTE parameters and SES-CD or laboratory data was analyzed by Pearson （normal distribution data） or Spearman （skewed distribution data）. Results SES-CD ranged from 1 to 15, with an average of 5.1±2.6. Among 49 cases, 13 were inactive, 19 were mild, and 17 were moderate-severe. There were 25 cases of intestinal obstruction or stenosis, including 24 cases in the active group and 1 case in the non-active group, and the difference was statistically significant （χ2=13.3, P〈 0.01）. The short diameter of lymph nodes was mor

关 键 词：CROHN病 体层摄影术 X线计算机 克罗恩病简化内镜活动性评分 

分 类 号：R574.62[医药卫生—消化系统] R816.5[医药卫生—内科学]