DECT碘定量技术与CT脂肪定量参数评价克罗恩病活动性的联合应用及对比研究  

Assessing Activity of Crohn's Disease Using Fat Quantification and Iodine Quantification:A Preliminary Study Based on DECT

作　　者：吕宗峻 马玉萍 李燕[1] 董宇寒 崔伯塔[2] 李海歌[1] 朱建国[1] LV Zong-jun;MA Yu-ping;LI yan;DONG Yu-han;CUI Bo-ta;LI Hai-ge;ZHU Jian-guo(Department of Medical Imaging,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,Jiangsu Province,China;Digestive Medical Center,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,Jiangsu Province,China)

机构地区：[1]南京医科大学第二附属医院医学影像科,江苏南京210011 [2]南京医科大学第二附属医院消化医学中心,江苏南京210011

出　　处：《中国CT和MRI杂志》2025年第4期157-160,共4页Chinese Journal of CT and MRI

基　　金：江苏省卫健委高层次卫生人才“六个一工程”(LGY2018072);江苏省高等学校自然科学研究项目(18KJB310007)。

摘　　要：目的本研究以简化版克罗恩病(CD)临床活动性评分Harvey-Bradshaw指数(HBI)为标准,通过测定脂肪定量参数、双能量CT(DECT)相对碘浓度参数,构建脂肪定量参数联合模型、相对碘浓度联合模型,对比模型间评价CD疾病活动性的效能,并探讨脂肪定量参数与患者体质量分数(BMI)的相关性。方法回顾性分析103例经临床、内镜及影像学诊断的CD患者,以HBI为标准,分为三组:Ⅰ组36例(缓解期,HBI≤4)、Ⅱ组35例(轻-中度活动期,5≤HBI≤8)、Ⅲ组32例(重度活动期,HBI≥9)。所有患者接受双能量CT小肠造影检查。并采集以下参数:动脉期、静脉期及延迟期相对碘浓度;腹部皮下及内脏脂肪体积、单层面皮下及内脏脂肪面积。同时采集患者的人口学及临床资料(年龄、性别、BMI)。运用Kruskal-Wallis H检验对脂肪定量参数、相对碘浓度参数进行组间差异检验。组间差异显著的参数通过二元Logistic回归构建脂肪定量参数联合模型及相对碘浓度联合模型,使用受试者工作特性曲线(ROC)评价模型的曲线下面积(AUC)、特异性、敏感性,并用Delong检验比较模型AUC的组间差异。使用Spearman相关系数分析脂肪定量参数与BMI的相关性。结果脂肪定量参数联合模型对比相对碘浓度联合模型,在Ⅰ组vs.Ⅲ组(AUCfat=0.885,AUCiodine=0.957,P=0.108)、Ⅱ组vs.Ⅲ组中(AUCfat=0.689,AUCiodine=0.769,P=0.394)鉴别诊断效能相仿;在Ⅰ组vs.Ⅱ组中,相对碘浓度联合模型鉴别诊断效能优于脂肪定量参数联合模型(AUCfat=0.759,AUCiodine=0.912,P=0.023)。脂肪定量参数中,腹部内脏脂肪指数(r=0.667,P<0.001)、腹部皮下脂肪指数(r=0.740,P<0.001)、单层面内脏脂肪指数(r=0.670,P<0.001)、单层面皮下脂肪指数(r=0.682,P<0.001)与BMI呈正相关。结论脂肪定量参数联合模型与相对碘浓度联合模型可用于评价CD活动性,而相对碘浓度联合模型在评价缓解组对比轻-中度活动组中更具优势。Objective The first aim is to build the combined fat quantitative parameters model and the combined normalize iodine concentration model by measuring the fat quantitative parameters and the relative iodine concentration parameters of dual-energy CT(DECT),based on the simplified version of Crohn's disease(CD)clinical activity score Harvey-Bradshaw index(HBI)as the standard.The second aim is to compare the efficacy of evaluating the activity of CD disease between the combined fat quantitative parameters model and the normalized iodine concentration(NIC)model.The third aim is to explore the correlation between fat quantitative parameters and body mass index(BMI).Methods A retrospective analysis was performed for 103 patients with CD diagnosed by clinical,endoscopic and imaging tests.According to the simplified version of the Harvey Bradshaw index(HBI),the patients were divided into three groups:36 in the GroupⅠ(remission group,HBI≤4),35 in GroupⅡ(mild-moderate activity group,5≤HBI≤8),32 in GroupⅢ(severe activity group,HBI≥9).All patients underwent dual-energy CT enhanced scanning.The parameters of fat quantification were as following:the total subcutaneous fat volume,the total visceral fat volume,the single slice subcutaneous fat area and the single slice visceral fat area.The parameters of DECT including NIC in arterial phase,venous phase and delay phase were also collected.The Kruskal-Wallis H test was used to analyze the fat quantitative parameters and NIC for the difference test between groups.The parameters with significant differences between groups were enrolled to construct the fat quantitative parameter model and the NIC model by binary Logistic regression.The receiver operating characteristic curve(ROC)was used to evaluate the area under the curve(AUC),specificity and sensitivity of the model,and Delong test was used to test the difference of the AUC between the groups.The correlation between fat quantification parameters and BMI was analyzed by Spearman test.Results In the GroupⅠversus Gro

关 键 词：双能量CT 克罗恩病 Harvey-Bradshaw指数 动脉期相对碘浓度 静脉期相对碘浓度 

分 类 号：R323.3[医药卫生—人体解剖和组织胚胎学]