伪膜性结肠炎MSCT表现并与结肠炎症性肠病的对照研究

发布时间：2019-06-12 13:36

【摘要】：目的：总结伪膜性结肠炎（Pseudomembranous Colitis，PMC）的多层螺旋CT（Multi-slice spiral CT，MSCT）表现，并与结肠炎症性肠病（Inflammatory BowelDisease，IBD）对照研究，旨在提高伪膜性结肠炎的CT诊断与鉴别诊断水平。材料和方法：收集并分析经临床、病理证实的伪膜性结肠炎及结肠炎症性肠病的影像资料。伪膜性结肠炎13例，其中男6例，女7例，年龄49-88岁，平均(68.62±11.90)岁。全部病例均有抗生素治疗史，均有腹泻症状，其中每日腹泻5-10次8例，10次5例。结肠炎症性肠病35例，包括克罗恩病(Crohn’s disease，CD)14例，溃疡性结肠炎(Ulcerative Colitis，UC）21例。14例结肠克罗恩病中，男8例，女6例，年龄16-80岁，平均(37.1±19.54)岁。21例溃疡性结肠炎中，男6例，女15例，年龄24-87岁，，平均(66.9±13.91)岁。结肠炎性肠病的临床症状包括腹痛、腹泻、粘液脓血便等。全部病例均行MSCT检查。检查前禁食8h以上，检查前1小时口服2.5%等渗甘露醇溶液或1.5%泛影葡胺1000-1500ml，病情危重或急腹症患者不口服对比剂直接扫描。CT扫描范围从膈顶至耻骨联合下缘，增强扫描分动脉期（延迟28-35s）、静脉期（延迟70-75s），对比剂为非离子型碘对比剂80-100ml，注射流率2.5-3.0ml/s。扫描图像经工作站后处理。以增强后肠壁强化程度大于邻近肠壁强化程度为强化增加的判断依据。以肠壁厚度≥4mm作为肠壁增厚的判断标准，肠壁增厚程度可分为轻度（4-10mm）、中度（11-15mm）、重度（15mm）。分析每一个病例的MSCT表现，包括病变部位，病变范围，肠壁增厚，强化增加，肠壁分层，肠系膜血管增多等。分别由两名具有胃肠道影像诊断经验，不知晓临床、病理和其他影像资料的高年资放射科医师对图像进行随机、独立阅片，描述病变征象，并做出诊断。所有数据均应用SPSS17.0统计软件进行统计分析。α=0.05，P0.05为差异有统计学意义。结果：⑴伪膜性结肠炎13例共67个结肠段受累，其中9例累及全结肠。13例均出现肠壁增厚，厚度范围10-28mm，平均(20±4.49)mm，其中重度增厚11例（84.62%），肠壁不规则、结节状增厚8例，强化增加7例，肠壁分层（“靶征”）7例，结肠皱襞异常增厚、内突（“指纹征”）3例，造影剂聚积于增厚的横行皱襞间（“手风琴征”）2例，肠系膜血管增多（“梳征”）6例，肠管周围索条状渗出12例，腹水9例，胸水7例，皮下水肿6例，系膜淋巴结短径平均（1.92±2.47）mm；⑵结肠克罗恩病14例，均为多节段病变，肠壁增厚14例，“靶征”11例，“梳征”14例，纤维脂肪增生14例，肠周蜂窝织炎7例，腹腔脓肿1例，肛周病变3例，淋巴结短轴平均（7.29±4.97)mm。溃疡性结肠炎21例，肠壁增厚19例，“靶征”12例，肠管形态改变12例，黏膜面锯齿状改变13例，黏膜下气泡13例，“梳征”11例，腹水4例。淋巴结短轴平均（3.52±2.6)mm；⑶与结肠炎症性肠病相比，伪膜性结肠炎病变范围广，肠壁重度并呈不规则、结节状增厚，易出现“指纹征”或“手风琴征”、肠周索条状渗出、腹水、胸水、皮下水肿（P0.05）。结肠克罗恩病易累及小肠，易出现“梳征”、肠周纤维脂肪增生及蜂窝织炎（P0.05）。溃疡性结肠炎易出现粘膜锯齿状改变、黏膜下气体和肠管形态改变（P0.05）；⑷13例伪膜性结肠炎患者均行纤维结肠镜检查，其中12例因肠腔狭窄结肠镜不能通过，狭窄段以上结肠未能完成检查。肠镜检查共发现病变结肠29段，少于MSCT的67个结肠段。MSCT评价病变结肠范围较纤维结肠镜有显著优势（P0.05）。结论：⑴伪膜性结肠炎的MSCT表现具有一定特征性，与结肠克罗恩病及溃疡性结肠炎有区别；⑵掌握伪膜性结肠炎和结肠炎症性肠病的MSCT特点并结合病史，有助于提高两者鉴别诊断水平；⑶MSCT在评价病变范围方面优于纤维结肠镜。
[Abstract]:Objective: To study the multi-slice spiral CT (MSCT) expression of pseudomembranous colitis (PMC) and to compare with the control of the inflammatory bowel disease (IBD) in the colon. The purpose of this study is to improve the CT diagnosis and differential diagnosis of pseudomembranous colitis. Materials and Methods: Collection and analysis of clinical, pathologically proven pseudomembranous colitis and imaging of the colon inflammatory bowel disease Materials:13 cases of pseudomembranous colitis,6 of which were male,7 female,49 to 88 years old, and average (68.62 to 11.90). The whole of the cases had a history of antibiotic treatment, with the symptoms of diarrhea, of which 5-10 times of daily diarrhea,8 cases,10 times A report of 35 cases of colonic inflammatory bowel disease, including 14 cases of Crohn's disease (CD),14 cases of ulcerative colitis (UC) and 21 cases of ulcerative colitis (UC). Example, age 24-87 years, average (66.9% 13.91) The clinical symptoms of colitis enteropathy include abdominal pain, diarrhea, and mucus pus and blood. et al. MSCT for all cases The test was carried out for more than 8 hours before the examination, 2.5% of the isotonic mannitol solution, or 1.5% of the diatrizoate,1000-1500ml, the condition of the disease or the acute abdomen were not directly scanned by the oral contrast agent in the patients with critical condition or acute abdomen before the examination. The scanning range of the CT is from the phrenic top to the pubic symphysis lower edge, the scanning sub-arterial phase (delayed 28-35 s), the venous phase (delay 70-75 s), the contrast agent is 80-100 ml of the non-ionic iodine contrast agent, and the injection flow rate is 2.5-3.0ml/ s. The scanned image is at the rear of the workstation The strengthening of the posterior wall of the intestinal wall is greater than that of the adjacent intestinal wall. The wall thickness of the intestinal wall can be divided into mild (4-10 mm), moderate (11-15 mm) and severe (15 mm) as a criterion for thickening of the intestinal wall with a thickness of 4 mm of the intestinal wall thickness. ). The MSCT manifestations of each case were analyzed, including the lesion site, the scope of the lesion, the thickening of the intestinal wall, the enhancement of the enhancement, the stratification of the intestinal wall, the increase of the mesenteric vessels, and the like. The images are randomly and independently read by two high-aged radiologists who have the experience of gastrointestinal image diagnosis, do not know the clinical, pathological and other image data, Break. All data are statistically separated using the SPSS17.0 statistical software The difference was significant between P = 0.05 and P 0.05. Results: There were 67 colon segments involved in 13 cases of pseudomembranous colitis, of which 9 cases were involved in the whole colon.13 of the 13 cases had the thickening of the intestinal wall, the thickness range of 10-28 mm, the average (20-4.49) mm, the severe thickening in 11 cases (84.62%), the irregular wall of the intestinal wall, the nodular thickening of 8 cases, and the enhancement of the increase. There were 7 cases,7 cases of intestinal wall delamination ("target sign"),7 cases of abnormal thickening of the colon,3 cases of internal process ("fingerprint sign"),2 cases of thickening,2 cases of internal process ("accordion sign"),6 cases of mesenteric vessel ("comb"),12 cases of strip exudation around the intestinal canal,9 cases of ascites, and chest. 7 cases of water,6 cases of subcutaneous edema, the average of the short diameter of the mesangial lymph nodes (1.92 and 2.47) mm,14 cases of Crohn's disease in the colon,14 cases of the intestinal wall thickening,11 cases of "target sign",14 cases of "comb",14 cases of fibrous fat hyperplasia,7 cases of periintestinal cellulitis, and the abscess of the abdominal cavity. 1 case of swelling,3 cases of perianal lesion and average of short axis of lymph node (7.29) 4.97 There were 21 cases of ulcerative colitis,19 cases of thickening of the intestinal wall,12 cases of "target sign",12 cases of the change of the intestinal canal,13 cases of the serrated change of the mucosal surface,13 cases of the submucosal bubbles,11 cases of "comb", and the abdomen. In 4 cases, the mean (3.52-2.6) mm of the short-axis of the lymph node, the range of the pseudomembranous colitis was wide, the intestinal wall was severe and irregular, the nodular thickening, the "fingerprint sign" or the "accordion sign" of the intestinal wall, the strip-like exudation of the intestine, the ascites, the pleural effusion and the subcutaneous edema (P0. 05). The colon Crohn's disease is easy to involve the small intestine, the appearance of the comb sign ", the periintestinal fiber fat hyperplasia and the cellulitis (P0. 05). The colon 29 of the lesion was found with an enteroscopy, which was less than 67 of the MSCT. Colonic segment. MSCT has a significant advantage over the fibrocolonoscope of the fibrocolonoscope (P0. Conclusion: The MSCT expression of pseudomembranous colitis is characteristic, and it is different from that of Crohn's disease and ulcerative colitis of the colon. The characteristics of the MSCT and the medical history of pseudomembranous colitis and inflammatory bowel disease of the colon can be grasped, and both of them can be improved. Do not diagnose the level; the MSCT is superior to the scope of the evaluation
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.5;R574.62

【参考文献】