能谱CT单能量小肠成像应用于克罗恩病临床评估的价值

发布时间：2018-09-19 08:00

【摘要】：目的探讨能谱CT单能量小肠成像应用于克罗恩病临床评估的价值。方法48例临床确诊为克罗恩病的患者行腹部CT能谱成像。原始图像经信号-噪声比(CNR)分析获得最佳成像Kev值,重建单能量图像。观察指标包括病变肠管位置、肠壁厚度、肠管狭窄程度、肠管强化程度、肠壁周围表现(浆膜层、脂肪间隙、系膜血管)、淋巴结肿大及相关并发症;计算正常肠壁与病变肠管动、静脉期强化率△A%与△V%。所有患者行内镜(结肠镜或小肠镜)检查,2例患者行手术治疗,金标准为活检病理。结果 (1)能谱CT单能量成像结合物质分离功能清晰显示病变肠管范围,病变肠段共132处,肠壁厚度3.1-26mm。病变累及空肠9例,回肠39例,回盲部42例,结直肠29例;25例显示肠壁水肿、增强同心圆样或分层样改变,39例浆膜层毛糙,18例显示肠管周围脂肪间隙模糊,36例显示肠系膜血管增多征象,其中24例有明显的"梳齿"征表现。22例显示肠系膜及腹膜后淋巴结增大,淋巴结大小约3.5-14.5mm。1例出现肠管穿孔,腹腔脓肿形成;3例肛瘘,4例不全小肠梗阻,2例有肠管狭窄伴胶囊内镜滞留。(2)平扫CD病变肠壁与正常肠壁CT值无显著性差异(P0.05),动脉期、静脉期CD病变肠壁强化程度及强化率均显著高于正常节段肠壁(P0.01);病变节段肠壁动脉期与静脉期肠壁强化率无显著性差异(P0.05)结论能谱CT单能量小肠成像对克罗恩病的诊断、临床评价具有明显优势,可作为CD的首选影像学检查方法。
[Abstract]:Objective to evaluate the value of energy dispersive CT single-energy small bowel imaging in clinical evaluation of Crohn's disease. Methods 48 patients with Crohn's disease were examined by CT. The optimal Kev value of the original image was obtained by signal to noise ratio (CNR) analysis, and the single energy image was reconstructed. The observed parameters included the location of the diseased intestine, the thickness of the intestinal wall, the degree of intestinal stenosis, the degree of enhancement of the intestine, the appearance of the intestinal wall (serous layer, fat space, mesenteric vessels), the enlargement of lymph nodes and the related complications. The normal intestinal wall and the diseased intestinal artery were calculated, the enhancement rate of vein phase A% and the V portion were calculated. All patients underwent endoscopic examination (colonoscopy or enteroscopy) and 2 patients underwent surgical treatment. The gold standard was biopsy and pathology. Results (1) CT single energy imaging combined with material separation function showed clearly the range of the diseased intestine with a thickness of 3.1-26mm. The lesions involved jejunum in 9 cases, ileum in 39 cases, ileocecal part in 42 cases, colorectal lesions in 29 cases and intestinal wall edema in 25 cases. Contrast-enhanced concentric or stratified changes in 39 cases of serosal roughness in 18 cases, there were 36 cases with vague fat space around the intestinal duct and 36 cases with increased mesenteric vessels. Among them, 24 cases showed obvious "comb" sign. 22 cases showed mesenteric and retroperitoneal lymph node enlargement, and the size of lymph node was about 3.5-14.5mm.1. There were 3 cases of anal fistula and 4 cases of intestinal obstruction with intestinal stenosis and capsule endoscope retention. (2) there was no significant difference in CT value between CD lesions and normal intestinal wall (P0.05). The enhancement degree and enhancement rate of intestinal wall in CD in venous phase were significantly higher than those in normal segment (P0.01), and there was no significant difference between arterial phase and venous phase (P0.05) in the diagnosis of Crohn's disease by energy dispersive CT single energy small bowel imaging. Clinical evaluation has obvious advantages and can be used as the preferred imaging method for CD.
【作者单位】：北京大学深圳医院医学影像科;
【基金】：国家科技支撑计划项目(项目编号:2013BAI07B01)
【分类号】：R574.62;R816.5

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