肠管Crohn病MRI、CT影像特征分析及MRI对其活动性评估应用与临床对比研究

发布时间：2018-04-13 11:14

本文选题：肠疾病 + 克罗恩病　；参考：《苏州大学》2014年硕士论文

【摘要】：本课题分为两部分，第一部分：以临床怀疑小肠克罗恩病患者为研究对象，并以肠镜、手术和病理证实为最终诊断结果，通过分析患者MRI、CT图像，总结Crohn患者的影像学特征，为临床诊断小肠Crohn病提高更好的依据。第二部分，以临床确诊Crohn患者为研究对象，以临床评价Crohn活动性为标准，通过患者MRI表现，评估其活动性，，为临床评估Crohn病的活动性提供影像依据。第一部分：肠管Crohn病MRI、CT影像特征及两者比较分析目的：以临床怀疑小肠CD患者为研究对象，并以肠镜、手术和病理证实为最终诊断结果，分析小肠克罗恩病的MRI、CT影像特征，并对二者进行分析比较，总结CD患者的影像学特征，为临床诊断小肠Crohn病提高更好的依据。材料与方法：选取临床怀疑为CD患者共43人，所有患者均接受了小肠MRI检查、腹盆腔CT平扫及增强检查、肠镜检查。两名高年资MRI科医生和两名高年资CT医生分别对43例小肠MRI和CT影像图像从病变部位、累及范围、肠壁形态及粘膜改变、肠腔外病变的显示情况等多方面予以判断。对结果予以汇总、记录，并与手术病理结果、内镜结果进行对比。结果：43例患者经肠镜、病理及手术证实的克罗恩病31例，溃疡性结肠炎4例、胃肠间质瘤2例、肠结核1例、淋巴瘤1例、腹型紫癜1例，正常3例。MRI对CD的检出率为93.5%（29/31），CT对CD的检出率为90.3%（28/31），MRI结合肠镜对CD的检出率为96%，且MRI对小肠疾病的检测效果同CT小肠检查一致性好（Kappa值=0.788,P 0.01）。病变多累及多节段肠管，MRI及CT平均每例2.8/3段，累及回盲部者27/25例（93%/89%）。MRI平扫即可显示肠壁增厚程度及“梳齿征”。克罗恩病患者肠壁轻中度增厚时以偏心性增厚为主（42/51、45/53），在重度增厚的肠壁中以环形增厚为主（24/31、25/32），在MRI与CT检查中两者均有统计学意义（P 0.001）。但MRI与CT在肠壁环形增厚与偏心性增厚中均无统计学意义（两者P0.05）。12例CD患者并发肛瘘或肛周脓肿，CT未能检出。结论：CT和MRI肠管扫描结果相仿，可成为小肠疾病的影像学检查方式；两者均可以清楚显示肠壁增厚程度及肠外病变，而MRI更适合于检测瘘管和脓肿，且MRI 更适用于病人长期随访应用。第二部分：MRI在评估Crohn病活动性中的应用及其临床对比研究目的：以临床确诊CD患者为研究对象，以临床评价CD活动性为标准，通过患者MRI图像表现，评估其活动性，为临床评估CD活动性提供影像依据。材料与方法：44例临床确诊为CD患者（其中男32例，女性12例），并搜集44例患者临床资料，所有患者均接受了肠管MRI检查。将患者根据资料及MRI图像分为活动期与慢性期。分析患者MR图像特征，包括病变肠管肠壁增厚及肠腔狭窄程度、有无“梳齿征”、肠系膜淋巴结增大、有无并发症（包括瘘管及窦道形成）等，由此分析患者活动性，并与临床对比。结果：44例临床确诊的CD患者中，临床评价为活动期者28例（轻中度活动期22例，重度活动期6例），慢性期16例。MRI图像评估为活动期27例，慢性期17例。以临床评估作为判断克罗恩病活动性的金标准，MRI评估活动性克罗恩病的敏感度为89.3%，特异度为87.5%，阳性预测值为92.6%，阴性预测值为82.4，且临床评价CD活动期及慢性期与MR评价效果一致性好（Kappa值=0.758）。克罗恩病肠管MRI表现为多节段肠壁增厚者37例，回肠末端（回盲部）受累者40例，淋巴结增大者18例，19例发现“梳齿征”，22例形成瘘（包括3例肠瘘及19例肛瘘）。活动期患者肠壁重度增厚、肠腔狭窄、肠外并发症中肛瘘、淋巴结肿大、梳齿征的发生率高于慢性期，两组间比较，差异有统计学意义（P 0.05）。结论：MR在诊断克罗恩病及评价克罗恩病活动性方面与临床评估一致性良好，而且通过对肠壁增厚、黏膜异常强化、病变部位、肠管外炎性反应等这些征象，做出了正确诊断。此外，MRI可作为克罗恩病肠外并发症检查的首选影像学方法。
[Abstract]:This subject is divided into two parts , the first part : the clinical suspicion of Crohn ' s disease as the research object , and the clinical diagnosis of Crohn ' s disease by analyzing the MRI and CT images of the patients . The second part , based on the clinical diagnosis of Crohn ' s disease , assesses the activity of Crohn ' s disease by MRI , and provides the basis for clinical assessment of the activity of Crohn ' s disease .

Part I : MRI , CT imaging features and comparative analysis of Crohn ' s disease

Objective : To investigate the MRI and CT imaging features of small intestinal Crohn ' s disease ( CD ) by clinical suspicion of small intestinal CD patients and to analyze the MRI and CT image features of Crohn ' s disease .

Materials and Methods : 43 patients with CD were suspected to be clinically suspected . All patients received small intestine MRI examination , abdominal pelvic CT plain scan and enhanced examination and enteroscopy . Two high - aged MRI doctors and two high - aged CT doctors respectively judged 43 cases of small intestine MRI and CT images from the lesion site , the accumulation range , the intestinal wall morphology and the mucosal changes , the display of the external lesions of the intestinal cavity , etc . The results were summarized and recorded , and compared with the pathological results and endoscopic results .

Results : There were 31 cases of Crohn ' s disease confirmed by enteroscopy , pathology and operation , 4 cases of ulcerative colitis , 2 cases of gastrointestinal stromal tumor , 1 case of intestinal tuberculosis , 1 case of lymphoma , 1 case of abdominal type purpura and 3 normal cases . The detection rate of CD was 90.3 % ( 28 / 31 ) . MRI and CT averaged 2.8 / 3 and 27 / 25 cases ( 93 % / 89 % ) . The thickening degree of intestinal wall and the " comb sign " were observed in patients with Crohn ' s disease ( 42 / 51 , 45 / 53 ) . In severe thickened intestinal wall , the thickening was mainly ( 24 / 31 , 25 / 32 ) . Both MRI and CT were statistically significant ( P 0.001 ) . But there was no statistical difference between MRI and CT ( P0.05 ) .

CT could not be detected by anal fistula or perianal abscess .

Conclusion : The results of CT and MRI were similar to those of MRI .
Both can clearly show intestinal wall thickening and extraintestinal lesions , while MRI is more suitable for detection of fistula and abscess , and MRI

and is more suitable for long - term follow - up application of patients .

Part Two : Application of MRI in Evaluation of Crohn ' s Disease Activity and Its Clinical Comparative Study

Objective : To evaluate the activity of CD patients with CD activity and to provide evidence for clinical evaluation of CD activity .

Materials and Methods : 44 cases were diagnosed as CD patients ( 32 males and 12 females ) , and 44 patients received clinical data . All patients were divided into active phase and chronic phase according to the data and MRI images . The patient ' s MR image features were analyzed , including the thickening of intestinal wall and the degree of intestinal stenosis , the presence or absence of " comb sign " , the enlargement of mesenteric lymph nodes , the presence or absence of complications ( including fistula and sinus formation ) , etc . The patient activity was analyzed and compared with clinical .

Results : Among 44 cases of CD patients diagnosed clinically , 28 cases ( 22 cases of mild to moderate activity , 6 cases with severe active period ) and 16 cases of chronic phase were evaluated clinically . The sensitivity of MRI was 89.3 % , specificity was 87.5 % , positive predictive value was 92.6 % , negative predictive value was 82.4 .

Conclusion : MR is good in diagnosis of Crohn ' s disease and evaluation of Crohn ' s disease activity , and is correctly diagnosed by these signs , such as thickening of intestinal wall , abnormal enhancement of mucous membrane , site of lesion , inflammatory response of intestinal canal , etc . Furthermore , MRI can be used as the preferred imaging method for Crohn ' s disease ' s disease .

【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R574

【参考文献】