双能量CT定量参数鉴别克罗恩病肠腔狭窄性质可行性初探

The Value of Dual-Energy CT and Morphology in the Evaluation of Stenosis in Crohn’s Disease

目的探讨双能量CT技术以及常规形态学判断肠道克罗恩病(CD)肠腔狭窄性质的可行性。方法回顾性分析经双源CT双能量扫描并经临床病理活检证实的肠道CD患者34例,共68段病变肠段,依据病理评分标准将肠段分为炎性肠段30段,纤维性肠段23段。对不同性质肠段CT小肠造影(CTE)征象评分,评价其与病理评分的相关性。不同性质肠段动、静脉期标准化碘浓度(NIC)、能谱曲线斜率(K)进行统计学分析,并应用受试者工作特性曲线(ROC)评价NIC及K鉴别肠段性质的能力。结果 CTE炎症性、纤维性评分和病理炎症性评分(r=0.510,P=0.014)、病理纤维性评分(r=0.439,P=0.025)正相关。动脉期炎性肠段及纤维性肠段NIC及K值差异有统计学意义(P<0.05);静脉期二者NIC及K值差异无统计学意义(P >0.05)。动脉期NIC及K值判断纤维性肠段的曲线下面积(AUC)分别为0.616、0.729,最佳阈值、特异度和敏感度分别为:NIC 0.12mg/ml、88.0%、52.2%;K 2.21、66.7%、77.3%。结论双能量CT成像动脉期NIC及K值测量对肠道CD肠腔狭窄性质判断有一定的价值。

Objective To investigate the feasibility of dual-energy CT technique and conventional morphology to determine the nature of intestinal Crohn's disease(CD) intestinal stenosis.Methods A retrospective analysis of 34 patients with intestinal CD confirmed by dual-source CT dual-energy scanning and clinical pathological biopsy,a total of 68 segments of intestinal lesions,according to pathological scoring criteria,the intestinal segment was divided into 30 segments of inflammatory bowel segment,fibrosis 23 segments of the intestine.The scores of CT small bowel angiography(CTE) in different intestine segments were evaluated and their correlation with pathological score was evaluated.The normalized iodine concentration(NIC) and the slope of the energy spectrum curve(K) of different intestine segments were statistically analyzed,and the receiver operating characteristic curve(ROC) was used to evaluate the ability of NIC and K to identify the nature of the intestinal segment.Results CTE inflammatory,fibrous score and pathological inflammatory score(r =0.510,P = 0.014) and pathological fibrosis score(r = 0.439,P = 0.025) were positively correlated.There were significant differences in NIC and K values between the inflammatory segment and the fibrous segment of the arterial phase(P <0.05).There was no significant difference in NIC and K between the two groups(P > 0.05).The area under the curve(AUC) of the fibrous tract in the arterial phase was 0.616 and 0.729,respectively.The optimal threshold,sensitivity and specificity were:NIC 0.12 mg/ml,88%,52.2%;K 2.21 66.7%,77.3%.Conclusion Dual-energy CT imaging of arterial phase NIC and K values ?? has certain value in judging the nature of intestinal CD stenosis.