克罗恩病的影像学诊断

The Imaging Diagnosis Crohn’s Disease

目的探讨克罗恩病的影像学表现,以提高对该疾病的诊断认识。资料与方法回顾性分析36例克罗恩病患者的X线、CT、肠镜表现,观察病变累及的部位、范围、形态、并发症等特点。男23例,女13例,年龄16～58岁,平均(34.9±11.2)岁。所有病例均经病理证实。其中,回盲部病变15例,末端回肠10例,空肠3例,结肠(升、横、降结肠)6例,乙状结肠+直肠2例。结果 16例小肠+结肠气钡双重造影中,多节段性病变10例,多发性、纵行裂隙状溃疡8例,"卵石征"12例。12例腹部窦道造影中,肠瘘7例,腹腔脓肿形成6例,窦道形成4例。26例全腹部平扫+增强扫描中,肠壁增厚(>4mm)24例,强化较明显22例,肠管周围蜂窝织炎15例,腹腔内脓肿8例,系膜区淋巴结肿大(直径>5mm)9例,系膜区血管束增多、增粗7例,不全性肠梗阻11例,腹腔积液7例。24例消化内镜检查中,纵行裂隙状溃疡13例,"铺路石样卵石征"16例,肠腔不规则狭窄18例。结论克罗恩病的影像学表现有其特征性,可与其他肠道疾病相鉴别,能为临床诊断及治疗提供依据。

Objective To investigate the imaging features of Crohn’s disease,so as to improve the diagnosis.Materials and Methods The X ray,CT and enteroscope data of 36 patient （23 males and 13 females,ages ranged from 16 to 58 years,with a mean of 34.9±11.2 years） with Crohn’s disease were retrospectively analyzed.The imaging features including the position,appearance,extent,and complication of the Crohn’s disease were evaluated.Thirty six patients underwent X ray examination,26 underwent abdominal plain and enhacement CT scan,and 24 patients underwent enteroscope examination.Results Fifteen lesions located in ileocecal junction,10 in ileum,3 in jejunum,6 in colon,2 in sigmoid and rectum.On the double contrast barium enema images,10 cases showed segmented lesions,8 showed multiple longitudinal slit-shaped ulcers,12 showed pebble sign.On the fistulography images,7 cases had intestinal fistula,6 had peritoneal abscess,4 had sinus tract.On the abdominal plain and enhacement CT,24 cases showed bowel wall thickening（4mm）,22 showed obviously enhanced,15 had dermatocellulitis,8 had peritoneal abscess,9 had lymphadenectasis（5mm）,7 had vascular bundle thickening,11 had incomplete intestinal obstruction,7 had seroperitoneum.For the enteroscope findings,13 cases had longitudinal slit-shaped ulcers,16 had pebble sign,18 had irregular enteric carity stenosis.Conclusion The Crohn’s disease has characteristic imaging findings,which can help us in diagnosis.