磁共振在克罗恩病随访中的临床对比

Magnetic resonance imaging for follow-up of Crohn's disease

目的:探讨磁共振成像(magnetic resonance imaging,MRI)在肠管克罗恩病(Crohn's disease,CD)随访中的应用价值,并与临床进行比较.方法:回顾性分析2007-06/2013-08临床确诊的CD患者33例(男24例,女9例)的临床资料,根据资料将患者分为活动期组与慢性期组.所有患者均接受了肠管MRI检查.分析患者MR图像特征,包括病变肠管肠壁增厚及肠腔狭窄程度、有无"梳齿征"、肠系膜淋巴结增大、有无并发症(包括瘘管及窦道形成)等,由此分析患者活动性,并与临床对比.结果:33例临床确诊的CD患者中,临床评价为活动期24例(中度活动期19例,重度活动期5例),慢性期9例.MRI图像活动期21例,慢性期12例.以临床评估作为判断CD活动性的金标准,MRI评估活动性CD的敏感度为79.2%,特异度为77.8%,阳性预测值为90.5%,阴性预测值为58.3%,且临床评价CD活动期及慢性期与MR评价效果一致性好(Kappa值=0.857,P<0.05).CD肠管MRI表现为多节段肠壁增厚者26例,回肠末端(回盲部)受累者29例,淋巴结增大者8例,17例发现"梳齿征",15例形成瘘道.活动期组患者肠壁中重度增厚、肠腔狭窄、肠外并发症中肛瘘、淋巴结肿大、梳齿征的发生率高于慢性期组,两组间比较,差异有统计学意义(P<0.05).结论:MR在诊断CD及评价CD活动性方面与临床评估一致性良好,而且通过对肠壁增厚、黏膜异常强化、病变部位、肠管外炎性反应等这些征象,作出了正确诊断.此外,MRI在检测瘘管和脓肿方面占很大优势.因此,MRI更适用于患者长期随访应用.

AIM： To investigate the value of magnetic resonance imaging （MRI） in the follow-up of Crohn＇s disease.METHODS： Thirty three patients （including 24 men and 9 women） with Crohn＇s disease diagnosed from June 2007 to August 2013 were analyzed retrospectively. According to the clinical data, the patients were divided into either an active phase group or a chronic phase group. All the patients underwent MRI, and the images were reviewed for the mural thickness, the degree of stenosis of diseased bowel segments, mesenteric lymph nodes, and complications （abscess, inflammatory mass, and fistula）. Disease activity was assessed according to a multi-parameter score, and MR findings were compared with clinical data.RESULTS： Of all patients, 24 were clinically identified to have active disease and 9 to have chronic disease, and MR-E identified active disease in 21 cases and chronic disease in the remaining 12. Using clinical diagnosis as the ＂gold standard＂, the sensitivity, specificity, positive predictive value and negative predictive value of MR for the depiction of disease activity of CD were 79.2%, 77.8%, 90.5% and 58.3%, respectively. The diagnostic performance of MRI was well matched with that of clinical diagnosis （Kappa = 0.857, P 〈 0.05）. In all the patients, 26 had two or more than 2 segments of the small bowl involved, 29 had the ileocecal area involved, 8 had enlarged mesareic lymph nodes, 17 had ＂comb sign＂, and 12 had fistula. There were significant differences in mural thickness, the degree of stenosis of diseased bowel segments, lymph nodes, ＂comb sign＂ and fistula between the active disease group and chronic disease group （P 〈 0.05 for all）. CONCLUSION： The diagnostic performance of MRE is well matched with clinical diagnosis. MRI is more effective in differentiating fistula and abscess, and more suitable for long-term follow-up.