胃十二指肠克罗恩病的影像表现及文献复习  

Imaging findings and literature review of gastroduodenal Crohn's disease

作　　者：刘灵灵[1] 杨芳[2] 周聪[3] 葛芳清[1] 缪飞[4] 赵雪松[4] LIU Lingling;YANG Fang;ZHOU Cong;GE Fangqing;MIAO Fei;ZHAO Xuesong(Department of Radiology,Nantong Hospital of Traditional Chinese Medicine,Nantong,Jiangsu Province 226001,China;Department of Spleen and Stomach,Nantong Hospital of Traditional Chinese Medicine,Nantong,Jiangsu Province 226001,China;Department of Surgery,Nantong Fourth People's Hospital,Nantong,Jiangsu Province 226005,China;Department of Radiology,Shanghai Ruijin Hospital,Shanghai 200025,China)

机构地区：[1]南通市中医院放射科,江苏南通226001 [2]南通市中医院脾胃科,江苏南通226001 [3]南通市第四人民医院外科,江苏南通226005 [4]上海瑞金医院放射科,上海200025

出　　处：《实用放射学杂志》2023年第7期1123-1126,共4页Journal of Practical Radiology

摘　　要：目的 探讨胃十二指肠克罗恩病(GCD)的影像学特点.方法 回顾性分析经病理或临床证实的7例GCD影像资料.7例均行CT平扫及增强扫描,其中1例行上消化道造影检查,1例行MR增强扫描.结果 7例均累及胃窦、幽门部及十二指肠近段,表现为胃流出道梗阻症状及体质量减低.CT检查3例处于急性期,表现为胃窦至十二指肠近段壁增厚,厚度约6~15 mm,增强后呈分层样强化,以静脉期显示最佳,黏膜面强化明显且凹凸不平、出现溃疡,黏膜下层水肿不强化,病变周围脂肪间隙模糊;4例处于缓解期,表现为胃窦至十二指肠近段壁较均匀增厚,厚度约3~10 mm,增强后均匀强化,病变周围脂肪间隙清楚.7例均有管腔移行性狭窄,多平面重建图像呈"羊角征".1例行上消化道造影检查出现胃窦部"羊角征".1例缓解期GCD同时行MR增强检查,在较均匀增厚十二指肠壁内发现少许脂肪沉积.结论 青少年患者影像学检查出现胃窦至十二指肠近段"羊角征",要考虑到GCD的可能.Objective To explore the imaging features of gastroduodenal Crohn's disease(GCD).Methods The images from 7 cases of GCD confirmed by pathology or clinic were analyzed retrospectively.All of the 7 cases underwent plain and enhanced CT scans,including 1 case of upper gastrointestinal radiography examination and 1 case of MR enhanced scan.Results All 7 cases were involved in the gastric antrum,the pyloric part,and the proximal duodenum,showing symptoms of gastric outflow obstruction and weight loss.CT findings:In the acute phase,3 cases showed a thickening wall from the gastric antrum to the proximal duodenum with a thickness of about 6-15 mm.They also showed stratified enhancement with the best performance in the venous phase.The enhancement of the mucosal surface was obvious,and the mucosal surface was uneven with ulcer-like changes.Edema of the submucosa was not enhanced,and the fat space around these lesions was fuzzy.In the remission phase,4 cases of GCD showed that the wall was thickened uniformly with a thickness of about 3-1o mm.These lesions were enhanced evenly,and the fat space around them was clear.Transitional stenosis occurred in 7 cases,so "ram's horn sign"could be found in the multi-plane reconstructed images.One case underwent upper gastrointestinal radiography,presenting as a "ram's horn sign" of the gastric antrum.One case of GCD in remission underwent MR enhancement at the same time,with a little fat deposition in the thickened duodenum wall.Conclusion If there is a "ram's horn sign"from the gastric antrum to the proximal duodenum on imaging of adolescent patients,the possibility of GCD should be considered.

关 键 词：胃十二指肠克罗恩病 上消化道造影 计算机体层成像 磁共振成像 

分 类 号：R573[医药卫生—消化系统] R814.42[医药卫生—内科学] R445.2[医药卫生—临床医学]