摘要
目的:探讨CT肠道成像(CTE)在回结肠克罗恩病(CD)活动性评估中的应用价值。方法:搜集我院经内镜、病理及临床随访确诊的CD患者共110例。110例患者均行常规结肠镜及CTE标准化检查,两种检查时间间隔小于1周。CTE检查主要评价病变部位、肠壁厚度、肠黏膜ΔCT值(门静脉期黏膜CT值-增强前黏膜CT值)、病变肠段周围最大淋巴结短径,有无肠壁分层强化、肠腔狭窄、肠系膜血管增粗(梳征)及肠系膜纤维脂肪增生。结肠镜检查根据克罗恩病简化内镜活动性评分(SESCD)将CD患者分为非活动组、轻微活动组和中重度活动组。结果:110例CD患者共评估298个病变肠段,其中非活动组80个,轻微活动组142个,中重度活动组76个。单因素分析结果表明,各组间的肠壁厚度、ΔCT值、淋巴结短径、肠壁分层强化及肠腔狭窄的差异均有统计学意义(P值均<0.05);而各组间的肠系膜血管增粗、肠系膜纤维脂肪增生的差异均无统计学意义(P>0.05)。相关性分析结果显示,肠壁厚度、ΔCT值、肠壁分层强化与SES-CD均呈中度相关,r值分别为0.535、0.787、0.676(P值均<0.01);肠腔狭窄与SES-CD呈轻度相关,r值为0.480(P<0.01)。通过多分类有序logistic回归模型初步计算出一个CTE定量评分系统:简化CTE评分=0.2×肠壁厚度+0.3×ΔCT值+1.5×肠壁分层强化+2×肠腔狭窄。通过对之后新收集的30例(88个肠段)CD患者的验证分析表明,该评分系统与SES-CD高度相关(r=0.866,P<0.01)。ROC曲线分析结果表明,当CTE评分为13.3时,其在区分CD活动组与非活动组中的灵敏度和特异度分别为80.3%、95.5%,曲线下面积(AUC)=0.906;当CTE评分=16.5时,其在区分CD轻微活动组与中重度活动组中的灵敏度和特异度分别为96.3%、90.2%,AUC=0.961。结论:CTE定量评分系统可用于CD病变活动性及严重程度的评估。
Objective:To explore the application values of CT enterography(CTE)in evaluating the activity of ileocolonic Crohn’s disease(CD).Methods:A total of 110 CD patients confirmed by endoscopy,pathology and clinical follow-up in our hospital were enrolled.All patients underwent routine colonoscopy and standardized CTE with the interval less than 1 week.CTE parameters included the lesion site,the bowel-wall thickness,intestinal mucosaΔCT value(CT value of mucosa in portal vein stage-CT value of mucosa before enhancement),the maximum short diameter of lymph nodes around the intestinal segment of the lesion,mural stratificated enhancement,luminal stenosis,mesenteric hyper-vascularity(manifested as "comb sign")and mesenteric fibro-fatty proliferation.The CD patients were divided into inactive,mild and moderate-severe active groups according to Crohn’s disease simplified endoscopic activity score(SES-CD).Results:298 intestinal segments in 110 CD patients were evaluated,in which 80,142 and 76 were inactive,mild active and moderate-severe active,respectively.Univariate analysis showed that there were significant differences in the bowel-wall thickness,ΔCT values,short diameter of lymph nodes,mural stratificated enhancement,and luminal stenosis among the three groups(P<0.05),while there were no significant differences in mesenteric hyper-vascularity and mesenteric fibro-fatty proliferation among the three groups(P>0.05).The correlation analysis showed that bowel-wall thickness,ΔCT values,and mural stratificated enhancement were moderately correlated with SES-CD(r values were 0.535,0.787,and 0.676,respectively;P<0.01);and luminal stenosis was mildly correlated with SES-CD(r value was 0.480;P<0.01).Through multinomial and ordinal logistic regression model,we initially calculated a quantitative CTE scoring system(simplified CTE score=0.2*wall thickness+0.3*ΔCT values+1.5* mural stratificated enhancement+2*luminal stenosis).Validation analysis of the newly collected 30 CD patients(88 intestinal segments)showed this CTE scoring system was highly correlated with the SES-CD(r=0.866,P<0.01).ROC curve analysis showed that when the cutoff value of CTE score was 13.3,the sensitivity and specificity in discriminating the active group from inactive group were 80.3% and 95.5%,respectively,and the area under the ROC curve was 0.906;when the cutoff value of CTE score was 16.5,the sensitivity and specificity in discriminating the mild active group from moderate-severe active group were 96.3%and90.2%,respectively,and the area under the ROC curve was 0.961.Conclusion:This quantitative CTE scoring system could be an effective way to assess the activity and severity of ileocolonic CD lesions.
作者
吴慧
程静云
王艳
冷小园
陈敏
黄梅芳
吴光耀
徐国斌
WU Hui;CHENG Jing-yun;WANH Yan(Department of Radiology,Zhongnan Hospital of WuhanUniversity,Wuhan 430071,China)
出处
《放射学实践》
北大核心
2020年第1期61-67,共7页
Radiologic Practice
基金
国家重点研发计划(No.2016YFC1304702)
深圳大学基金(No.85706-0000040544).
关键词
克罗恩病
CT肠道成像
体层摄影术
X线计算机
克罗恩病简化内镜活动性评分
CTE定量评分系统
Crohn’s disease
Computed tomography enterography
Tomography,X-ray computed
Simplified endoscopic activity score for Crohn disease
Quantitative CTE score system
