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多排螺旋CT小肠成像在Crohn病中的诊断价值

作者:彭明洋 张卫东 马跃虎 冯 敏 卢铃铨 殷信道 顾建平

所属单位:南京医科大学附属南京医院(南京市第一医院)放射影像科(江苏 南京 210006)

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摘要

目的探讨CT小肠成像(CTE)对 Crohn病的诊断价值。方法 回顾经CTE 检查、病理证实的Crohn病患者25例, 两位医生在不知道病理的情况下采用盲 法分别对其CTE表现进行分析。结果 两 位医生通过CTE诊断Crohn病的准确度分 别为90.60%和87.40%,CTE可清晰显示 Crohn病的病变部位及肠管改变,25例患 者中,仅累及小肠的12例(48%),其中单 纯回肠末端或回盲部受累5例,小肠及结 肠同时受累的10例(40%),仅累及结肠的 3例(12%)。所有25例Crohn病CTE均表现 为肠管增厚、肠腔狭窄,增强扫描肠壁 呈明显层样或整体强化,肠管轴位像见 “靶”征,系膜血管增多、粗大。18例 (72%)见“梳样”征。15例(60%)见肠系 膜淋巴结增大,边缘清楚。2例(8%)可见 内瘘形成,1例(4%)不全小肠梗阻。结论 CTE检查能多方位显示肠壁、肠腔、肠系 膜、腹腔内淋巴结的异常情况及相应的 并发症,可以作为诊断Crohn病的首要检 查方法。

Objective To evaluate the diagnostic value of CT imaging of the small intestine (CTE) for Crohn's disease. Methods 25 patients with pathologically confirmed and CTE examination were analyzed retrospectively. Two doctors without knowing pathological situations were blinded to analyze the performance of its CTE. Results Of two doctors diagnose Crohn's disease by CTE accuracy were 90.60% and 87.40%, CTE can clearly show lesions and bowel changes, in 25 patients, 12 cases involving only the small intestine (48%), which simple terminal ileum or ileocecal involvement in 5 cases, small intestine and colon simultaneously involved in 10 cases (40%), only 3 cases involving the colon (12%). All 25 cases of Crohn's disease CTE showed thickening of the bowel, intestinal stenosis, intestinal enhanced scan showed a layer-like or overall enhancement, bowel axial like to see a "target" sign, increased mesenteric vessels. 18 cases (72%) see "comblike" symptoms. 15 cases (60%) see the mesenteric lymph node enlargement, clear edge. 2 cases (8%) seen in the fistula formation, one case (4%) incomplete small bowel obstruction. Conclusion CTE examination can multi-faceted display the abnormalities of intestinal wall, intestine, mesenteric, intra-abdominal lymph node and corresponding complications as a primary screening method can diagnose Crohn's disease.

【关键词】CT小肠成像;Crohn病;诊断

【中图分类号】R574

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2015.07.025

前言

克罗恩病(Crohn's disease,CD)是一种病因未明确的慢性肉芽肿 性疾病,可发生在胃肠道的任何部位,以终末回肠和近端结肠居多, 目前病因和发病机制未明。临床上主要以腹痛、腹泻、腹块、便血、 瘘管形成和肠梗阻等常见,可伴有发热、贫血、营养障碍以及关节、 皮肤、眼、口腔、黏膜、肝脏等肠外损害,临床表现复杂且缺乏特征 性,给诊断和治疗带来较大困难[1,9]。由于肠道自然充盈不良,盘曲 重叠,以往临床主要依靠消化道造影和肠镜检查诊断肠道病变。近年 来,多层螺旋CT小肠成像(Computed Tomography Enterography,CTE) 使肠道疾病的影像学诊断能力得到了很大提高,在临床上应用越来越 广泛[2]。本文通过分析25例经病理证实的CD患者CT征象,评价多排螺 旋CT对于诊断小肠CD的价值。