摘要
目的：分析CTd,肠造影（CTE）对克罗恩病（CD）治疗前后疗效判定的价值。方法：回顾性研究，入选2008年6月-2011年6月在我院经临床表现、影像学检查、肠镜、手术和病理检查确诊为克罗恩病的患者50例，所有患者均符合WHO关于CD的诊断标准。治疗方法包括内科治疗或外科手术治疗，且经治疗后判断疗效为有效或临床缓解。所有患者均于治疗前后行CTE检查，并同时行肠镜检查，两次CTE检查相距3～6个月。分析每一病灶的部位、肠壁厚度、肠壁增厚模式、肠腔狭窄、肠管直径、强化特点、并发症及周围脏器受累情况，并结合MSCT重建图像，最后做出诊断。CT值及肠壁厚度均测量2次取平均值。数据分析应用SPSS11．5统计软件进行分析。结果：50例CD患者治疗后病变范围缩zJq7例，占34％；病变范围不变30例，占60％；病变范围增大3例，占6％。经有效治疗后41例（82．0％）患者肠壁变薄、5例（10％）不变、4例（8％）增加。全部病例治疗前肠壁厚度为8．8±2．9mm（4．1～14．9mm），治疗后肠壁厚度为6．2±1．7mm（P〈0．01）。治疗后肠壁门脉期CT值较治疗前有所降低（P〈0．01）。治疗后内膜强化的类型较治疗前也有显著变化，治疗后A型减少，47．6％，D型增加增加48．5％（P〈0．05）。治疗后梳征较治疗前显著减少（60％vs88％）（P〈0．01）。治疗后中重度狭窄的发生率较治疗前有所减少（P〈0．01）。受试者操作特征曲线分析（ROCanalysis）及Logistic回归分析结果均显示黏膜强化及肠壁增厚是判定CD活动度最有效的指标。结论：CTE可作为首选的影像学方法判定CD疾病活动度及评价疗效并指导治疗。
Purpose： The purpose of this study was to determine the value of CT enterography （CTE） in evaluating the treatment efficacy of Crohn＇ s disease （CD）. Methods： We retrospectively recruited 50 definitely diagnosed CD patients through clinical findings, imaging examinations, enteroscopy, surgery and pathology results in our hospital from June 2008 to June 2011. All patients met the WHO criteria of CD diagnosis. Treatment management included medical treatment or surgical treatment. All recruited patients had clinical remission after treatment. Both CTE and enteroscopy were performed before and after treatment. Interval time between two CTE examninations was about 3-6 months. Each lesion was analyzed and recorded with its location, bowel wall thickness, bowel wall thicktfess type, luminal stenosis, intestinal diameter, enhancement characteristic, complicatons and adjacent organs involvement, and final diagnosis was made based on those findings and reconstruction images. Quantitative parameter such as CT value and bowel wall thickness was measured. Data analysis was done by using SPSSll.5 software. Results： After treatment, the disease extent was alleviated, not changed and enlarged in 17（34%）, 30（60%） and 3（6%） patients, respectively. Alleviated bowel wall thickening was observed in 41（82%） patients, 5 （10%） patients had no obvious changes, while 4（8%） patients got more thickening. Mean bowel thickness was 8.8±2.9mm （4.1-14.9mm） before treatment, and 6.2±1.7mm after treatment. Mucosal enhancement was greatly decreased after treatment. Bowel wall thickness type changed obviously, type A decreased 47.6% whereas type D increased 48.5% （P〈0.05）. The incidence of comb sign was significantly decreased after treatment （60% vs 88%） （P〈0.01）. The incidence of severe luminal stenosis was decreased after treatment （P〈0.01） . ROC analysis and logistic regression analysis showed mucosal tenhancement and and bowel wall thickness were the most valuable parameters for the evaluation of CD activity. Conclusion： CTE can be the first line imaging modality for CD activity evaluation.
出处
《中国医学计算机成像杂志》
CSCD
北大核心
2015年第4期337-343,共7页
Chinese Computed Medical Imaging
基金
浦东新区优秀青年人才计划PWRq2011-04~~
