多层螺旋CT在诊断鉴别克罗恩病与肠结核中的应用  

Application of Multi-slice Spiral CT in the Diagnosis and Identification of Crohn’s Disease and Intestinal Tuberculosis

作　　者：韩舒[1] 陈殿森 HAN Shu;CHEN Dian-sen(Department of Henan University of Science and Technology,the First Affiliated Hospital Image center of Luoyang 471003,Henan Province,China)

机构地区：[1]河南科技大学第一附属医院影像中心,河南洛阳471003 [2]上海复旦大学附属中山医院影像中心,上海200032

出　　处：《中国CT和MRI杂志》2020年第4期123-126,共4页Chinese Journal of CT and MRI

摘　　要：目的探究多层螺旋CT在诊断鉴别克罗恩病(CD)与肠结核(ITB)中的应用。方法回顾性分析2013年2月-2018年2月上海复旦大学附属中山医院确诊为克罗恩病(n=62)与肠结核(n=47)患者的多层螺旋CT影像学资料,分析比较两种疾病之间统计学差异。结果两种疾病病变累及部位、多节段跳跃性病灶、肠壁增厚方式、肠壁增强方式、肠系膜淋巴结增大、肠系膜改变、"梳状征"、肠腔脓肿或瘘管形成及腹腔积液发生率比较,差异均有统计学意义(P<0.05),ITB最常发生于回盲部(78.72%),明显高于回盲部CD发生率(46.77%),差异有统计学意义(P<0.05);CD多节段跳跃性病灶、肠壁非对称性增厚、肠壁均匀强化、肠壁分层或不均匀强化、肠系膜纤维脂肪增生、"梳状征"、腹腔积液、肠腔脓肿或瘘管形成均较ITB多见(P<0.05);ITB肠壁对称性增生、肠系膜淋巴结均匀强化、淋巴结环形强化、肠系膜血管增生均较CD多见(P<0.05);CD肠壁厚度及肠周淋巴结短径均较ITB高(P<0.05),CD肠壁及腹水强化程度均较ITB低(P<0.05)。结论CD与ITB的CT影像表现各具一定特点,采用多层螺旋CT检查对CD与ITB之间的鉴别诊断具有较高临床应用价值。Objective To explore the application of multi-slice spiral CT in the diagnosis and identification of Crohn’s disease(CD) and intestinal tuberculosis(ITB). Methods The multi-slice spiral CT imaging data of patients with CD(n=62) and ITB(n=47) diagnosed in the hospital during the period from February 2013 to February 2018 were retrospectively analyzed. Statistical differences between the two diseases were analyzed. Results There were significant differences between the two diseases in involved sites of lesions, multilevel jumping lesions, mode of intestinal wall thickening, mode of intestinal wall thickening, mesenteric lymph node enlargement, mesenteric changes, combtype sign, incidence of intestinal abscess or fistula formation and ascites(P<0.05). The incidence of ITB in the ileocecal junction(78.72%) was significantly higher than that of CD(46.77%)(P<0.05). Multilevel jumping lesions, asymmetrical thickening of the intestinal wall, homogeneous enhancement of the intestinal wall, stratification or inhomogeneous enhancement of the intestinal wall, mesenteric fibrofatty tissue hyperplasia, comb-type sign, ascites, intestinal abscess or formation of fistula were more common in patients with CD than those with ITB(P<0.05). Symmetric hyperplasia, homogeneous enhancement of mesenteric lymph nodes, ring-shaped enhancement of lymph nodes and mesenteric vascular hyperplasia were more common in patients with ITB than those with CD(P<0.05). The intestinal wall thickness and short diameter of peri-intestinallymph nodes in patients with CD were larger than those in patients with ITB(P<0.05), and the degree of intestinal wall and ascites enhancement in patients with CD was lower than that in patients with ITB(P<0.05). Conclusion CT findings of CD and ITB are characteristic. Multi-slice spiral CT is of high clinical value for the differential diagnosis of CD and ITB.

关 键 词：克罗恩病 肠结核 体层摄影术 X线计算机 

分 类 号：R574.6[医药卫生—消化系统] R445.3[医药卫生—内科学]