CT小肠造影鉴别诊断克罗恩病与肠结核的初步研究

发布时间：2018-03-21 02:41

本文选题：克罗恩病　切入点：肠结核　出处：《南昌大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：探讨CT小肠造影检查用于鉴别诊断克罗恩病和肠结核的可行性，并探讨其鉴别诊断价值。方法：回顾性分析2011年8月至2012年7月在南昌大学一附医院消化科住院并经过随访确诊为克罗恩病及肠结核患者的CT小肠造影（CTE）影像资料，由2名副高以上职称的胃肠影像学医师盲法阅片并对其CT征象进行系统分析，对其中有小肠累及的患者(克罗恩病及肠结核各19例）的影像征象进行统计学分析。结果：克罗恩病患者中受累肠壁分层强化、肠壁不对称性增厚、病灶呈多节段跳跃性、纤维脂肪增生、直小血管充血等五个指标更为常见。而在肠结核患者中较多表现为肠壁不均匀性强化、肠壁对称性增厚、淋巴结环形强化等三个指标。将每个支持克罗恩病的影像指标设置为+1分，而支持肠结核的则为-1分，依此计算每一患者的影像特征总分值。然后进一步绘制依据上述影像特征总分值鉴别克罗恩病和肠结核的ROC曲线，分析得出鉴别的最佳临界值为1.5，提示若八个影像分值总和＞1.5诊断为克罗恩病，反之则为肠结核。利用此方法进行诊断，38人中有34人诊断正确，总符合率为89.5%，，4人诊断错误，误诊率为10.5%。结论：利用CT小肠造影检查的影像征象进行系统分析的方法对诊断和鉴别诊断克罗恩病与肠结核具有一定的临床价值。
[Abstract]:Objective: to investigate the feasibility and value of CT enterography in differential diagnosis of Crohn's disease and intestinal tuberculosis. Methods: the CT enterography (CTE) images of patients with Crohn's disease and intestinal tuberculosis were analyzed retrospectively from August 2011 to July 2012 in the Department of Digestive Diseases of the affiliated Hospital of Nanchang University. The CT findings of 2 gastrointestinal imaging physicians with subtropical high professional titles and above were analyzed systematically. The imaging features of the patients with small bowel involvement (19 cases of Crohn's disease and 19 cases of intestinal tuberculosis) were analyzed statistically. Results: in the patients with Crohn's disease, the involved intestinal wall was enhanced by stratification, the intestinal wall was asymmetrically thickened, the lesion was multisegmental jump, and the fibrous fat was hyperplastic. It is more common in patients with intestinal tuberculosis than in patients with intestinal tuberculosis, but it is characterized by uneven enhancement of intestinal wall and symmetrical thickening of intestinal wall. Three indicators, including circular enhancement of lymph nodes, were set to 1 for each image supporting Crohn's disease, and -1 for those supporting intestinal tuberculosis. Based on this, the total score of the imaging features of each patient was calculated. Then the ROC curve was further drawn to distinguish Crohn's disease from intestinal tuberculosis based on the total score of the above image features. The results showed that the best critical value for differential diagnosis was 1.5, suggesting that if the sum of the eight imaging scores > 1.5 was diagnosed as Crohn's disease, otherwise it was intestinal tuberculosis. 34 out of 38 patients were diagnosed correctly by this method, and the total coincidence rate was 89.55.The total coincidence rate was 89.5%. The misdiagnosis rate was 10.5%. Conclusion: the method of systematic analysis of CT small bowel imaging findings has certain clinical value in the diagnosis and differential diagnosis of Crohn's disease and intestinal tuberculosis.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5

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