超声造影定量分析评估克罗恩病炎症活动程度的应用价值  

Contrast-enhanced ultrasound quantitative analysis for assessment of disease activity of Crohn′s disease

作　　者：王韦力 程文捷[2] 文艳玲[2] 高翔[3] 郅敏[3] 余俊丽[2] 陈瑶[2] 刘小银[2] 刘广健[2] Wang Weili;Cheng Wenjie;Wen Yanling;Gao Xiang;Zhi Min;Yu Junli;Chen Yao;Liu Xiaoyin;Liu Guangjian(Department of Ultrasound,the Third Affiliated Hospital of SunYat-Sen University,Guangzhou 510630,China;Department of Ultrasound,the Sixth Affiliated Hospital of SunYat-Sen University,Guangzhou 510655,China;Department of Gastroenterology,the Sixth Affiliated Hospital of SunYat-Sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第三医院超声科,广州510630 [2]中山大学附属第六医院超声科,广州510655 [3]中山大学附属第六医院消化内科,广州510655

出　　处：《中华医学超声杂志（电子版）》2019年第12期949-955,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨超声造影(CEUS)定量分析评估克罗恩病(CD)炎症活动程度的应用价值。方法回顾性分析2014年2月至8月于中山大学附属第六医院就诊或随访的55例经临床、内镜、病理综合诊断的CD患者。以血清超敏C反应蛋白(hs-CRP)水平为诊断金标准,评价能量多普勒(PDI)Limberg分级、CEUS增强模式及定量分析参数[峰值强度(PI)、上升时间(RT)、达峰时间(TTP)]评估CD炎症活动程度的价值。采用独立样本t检验比较炎症活动期与炎症非活动期CD患者CEUS定量分析参数PI、RT及TTP;以hs-CRP水平作为诊断金标准,分别绘制PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT及TTP诊断CD炎症活动程度的受试者工作特征(ROC)曲线,并采用χ^2检验比较曲线下面积。结果hs-CRP水平显示,本组55例CD患者中,炎症活动期39例,炎症非活动期16例。以hs-CRP水平作为诊断金标准,PDI技术诊断CD炎症活动程度的Youden指数为0.49,CEUS增强模式诊断CD炎症活动程度的Youden指数为0.25;炎症活动期CD患者PI高于炎症非活动期CD患者[(22.7±3.4)dB vs(18.5±3.7)dB],而炎症活动期CD患者RT及TTP均短于炎症非活动期CD患者[(6.1±1.6)s vs(7.4±3.0)s,(7.5±1.9)s vs(9.3±2.9)s],且差异均有统计学意义(t=-4.1,P<0.001;t=2.1,P<0.05;t=2.8,P<0.01);ROC曲线显示,CEUS定量分析参数PI、RT、TTP诊断CD炎症活动期的阈值分别为19 dB、6.2 s、8.7 s,Youden指数分别为0.56、0.39和0.45;PDI技术、CEUS增强模式、CEUS定量分析参数PI、RT、TTP诊断CD炎症活动程度的曲线下面积分别为0.74、0.62、0.82、0.65、0.74。CEUS定量分析参数PI诊断CD炎症活动程度的曲线下面积大于CEUS增强模式诊断CD炎症活动程度的曲线下面积,且差异有统计学意义(P=0.03),而其余曲线下面积两两比较差异均无统计学意义。结论CEUS定量分析评估CD炎症活动程度的能力优于CEUS定性分析,与传统PDI Limberg分级方法无显著差异。且CEUS定量分析Objective To evaluate the clinical value of contrast-enhanced ultrasound(CEUS)quantitative analysis in assessing the disease activity of Crohn′s disease(CD).Methods From February to August 2014,55 consecutive patients who were comprehensively confirmed to have CD by clinical,endoscopic,and pathologic evidence were prospectively evaluated.Using the concentration of high-sensitivity C-reactive protein(hs-CRP)as the reference standard,the diagnostic performance of power Doppler image(PDI)according to Limberg classification,the enhancement patterns on CEUS,and quantitative parameters including peak intensity(PI),rising time(RT),and time to peak(TTP)were analyzed and compared.Quantitative parameters between active and inactive CD patients were compared by the independent t-test.The receiver operating characteristic curve(ROC)of each parameter was analyzed,and the area under the ROC(AUROC)was compared by theχ^2-test.Results There were 39 patients with active and 16 with inactive CD according to the level of hs-CRP.PDI according to Limberg classification had a Youden index of 0.49,while CEUS patterns had a Youden index of 0.25.Quantitative analysis showed higher PI and shorter RT and TTP in patients with active disease than in those with inactive CD(P<0.05).ROC analysis showed that the cutoff values in assessment of disease activity were:PI>19 dB,RT≤6.2 s,and TTP≤8.7 s.By using the quantitative parameters presented above as diagnostic standard,the Youden indexes were 0.56,0.39,and 0.45,respectively.Pairwise comparisons showed that PI had higher efficiency in assessing the inflammatory activity of CD in comparison to qualitative analysis(P<0.05).Conclusion CEUS quantitative analysis performs better than qualitative analysis in the assessment of the activity of CD.Although the performance of CEUS quantitative analysis is equal to that of PDI,the former is more objective and should be recommended in clinical practice.

关 键 词：CROHN病 超声检查 造影剂 

分 类 号：R445.1[医药卫生—影像医学与核医学] R574.62[医药卫生—诊断学]