多排螺旋CT小肠成像在Crohn病中的诊断价值

The Diagnostic Value of Multi-slice Spiral CT Small Bowel Imaging in Crohn's Disease

目的探讨CT小肠成像(CTE)对Crohn病的诊断价值。方法回顾经CTE检查、病理证实的Crohn病患者25例,两位医生在不知道病理的情况下采用盲法分别对其CTE表现进行分析。结果两位医生通过CTE诊断Crohn病的准确度分别为90.60%和87.40%,CTE可清晰显示Crohn病的病变部位及肠管改变,25例患者中,仅累及小肠的12例(48%),其中单纯回肠末端或回盲部受累5例,小肠及结肠同时受累的10例(40%),仅累及结肠的3例(12%)。所有25例Crohn病CTE均表现为肠管增厚、肠腔狭窄,增强扫描肠壁呈明显层样或整体强化,肠管轴位像见"靶"征,系膜血管增多、粗大。18例(72%)见"梳样"征。15例(60%)见肠系膜淋巴结增大,边缘清楚。2例(8%)可见内瘘形成,1例(4%)不全小肠梗阻。结论CTE检查能多方位显示肠壁、肠腔、肠系膜、腹腔内淋巴结的异常情况及相应的并发症,可以作为诊断Crohn病的首要检查方法。

Objective To evaluate the diagnostic value of CT imaging of the small intestine（CTE） for Crohn＇s disease. Methods 25 patients with pathologically confirmed and CTE examination were analyzed retrospectively. Two doctors without knowing pathological situations were blinded to analyze the performance of its CTE. Results Of two doctors diagnose Crohn＇s disease by CTE accuracy were 90.60% and 87.40%, CTE can clearly show lesions and bowel changes, in 25 patients, 12 cases involving only the small intestine（48%）, which simple terminal ileum or ileocecal involvement in 5 cases, small intestine and colon simultaneously involved in 10 cases（40%）, only 3 cases involving the colon（12%）. All 25 cases of Crohn＇s disease CTE showed thickening of the bowel, intestinal stenosis, intestinal enhanced scan showed a layer-like or overall enhancement, bowel axial like to see a ＂target＂ sign, increased mesenteric vessels. 18 cases（72%） see ＂comblike＂ symptoms. 15 cases（60%） see the mesenteric lymph node enlargement, clear edge. 2 cases（8%） seen in the fistula formation, one case（4%） incomplete small bowel obstruction. Conclusion CTE examination can multi-faceted display the abnormalities of intestinal wall, intestine, mesenteric, intra-abdominal lymph node and corresponding complications as a primary screening method can diagnose Crohn＇s disease.