CT小肠造影对克罗恩病疗效评价的研究

发布时间：2018-03-26 22:13

本文选题：克罗恩病　切入点：CT小肠造影　出处：《中国医学计算机成像杂志》2015年04期

【摘要】：目的:分析CT小肠造影(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小17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(P0.01)。治疗后肠壁门脉期CT值较治疗前有所降低(P0.01)。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%(P0.05)。治疗后梳征较治疗前显著减少(60%vs 88%)(P0.01)。治疗后中重度狭窄的发生率较治疗前有所减少(P0.01)。受试者操作特征曲线分析(ROC analysis)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。
[Abstract]:Objective: to analyze the value of CT enterography (CTE) in evaluating the curative effect of Crohn's disease (CDT) before and after treatment. Methods: retrospective study was conducted in our hospital from June 2008 to June 2011. Fifty patients with Crohn's disease were diagnosed by surgery and pathology. All patients met the WHO criteria for the diagnosis of CD. All the patients were examined with CTE before and after treatment, and the interval between the two CTE examinations was 3 ~ 6 months. The location of each lesion, the thickness of intestinal wall and the pattern of thickening of intestinal wall were analyzed. Lumen stenosis, intestinal diameter, enhancement characteristics, complications and surrounding viscera involvement, combined with MSCT reconstruction, Finally, the average value of CT and the thickness of intestinal wall were measured twice. The data were analyzed by SPSS11.5 software. Results the range of lesion was reduced in 17 cases (34%) in 50 cases of CD after treatment, and the range of lesion was unchanged in 30 cases. The lesions were enlarged in 3 cases. The thickness of intestinal wall was 8.8 卤2.9 mm / 14.9 mm before treatment and 6.2 卤1.7 mm P0.01.The CT value of portal vein phase after treatment was lower than that before treatment. The types of intimal enhancement after treatment were significantly different from those before treatment. After treatment, the incidence of moderate and severe stenosis decreased by 47.6g / D and increased by 48.5a / P 0.05.The incidence of moderate and severe stenosis after treatment was significantly lower than that before treatment, and the incidence of moderate and severe stenosis was lower than that before treatment. The operating characteristic curve analysis of subjects and Logistic regression analysis showed that the incidence of moderate and severe stenosis after treatment was significantly lower than that before treatment. The results showed that the enhancement of mucous membrane and the thickening of intestinal wall were the most effective indexes to determine the CD activity. Conclusion: CTE can be used as the first choice imaging method to evaluate CD disease activity, evaluate the curative effect and guide the treatment.
【作者单位】：上海交通大学医学院附属第九人民医院放射科;同济大学附属东方医院放射科;上海交通大学医学院附属瑞金医院;
【基金】：浦东新区优秀青年人才计划PWRq2011-04~~
【分类号】：R574.62;R816.5

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