磁共振动态增强在克罗恩病疗效评估中的应用

Assessment of therapeutic response in Crohn's disease using dynamic contrast enhanced MRI

目的运用磁共振动态增强(DCE-MRI)研究克罗恩病(CD),讨论磁共振定量参数在疗效评估中的价值。方法收集22例于我院接受粪菌移植(FMT)治疗的CD患者,治疗前、后分别接受DCE-MRI检查,测量病变段肠壁容积转运常数(Ktrans);同时记录患者治疗前后C反应蛋白(CRP)和Harvey-Bradshow指数(HBI)。使用配对t检验,观察治疗前后CRP、HBI和Ktrans的变化情况。对治疗前后Ktrans的变化程度(ΔKtrans)与对应的ΔHBI、CRP行相关性分析。采用受试者工作特征曲线(ROCs)评价Ktrans在CD疗效评估中价值。结果 CD患者经治疗后,临床指标显著下降[CRP:(62.68±31.86)vs.(43.55±29.63)mg/L,P=0.008;HBI:(7.18±2.10)vs.(5.73±2.33),P=0.012],病变段肠壁Ktrans有显著差异:(1.86±0.87)vs.(1.39±0.83)min-1,P=0.017。ΔKtrans与临床指标的变化程度(CRP、ΔHBI)之间存在显著相关性。Ktrans能准确评估疗效,曲线下面积(AUC)为0.906。结论 DCE-MRI的定量参数(Ktrans)能够有效评估CD患者的治疗效果。

Objective To study Crohn＇ s disease （CD） using dynamic contrast enhanced MRI （DCE-MRI） and to investigate the value of quantitative parameter in assessment therapeutic responses. Methods Twenty two patients with CD were enrolled in- to the study. Parameters of DCE-MRI [ vascular transfer constant （ K ） ] in the ileocecum were compared between before and after fecal microbiota transplantation （FMT） treatment. The differences of clinical indicators [ C-reactive protein （ CRP）, Harvey- Bradshaw index （HBI） ] and DCE-MRI parameter （ K ） between pre-and post-treatment were calculated by a Student＇ s 2- tailed, paired t-test. The cmTelations between percent changes of clinical indicators （CRP, HBI） with DCE-MRI parameter （ K ） were analyzed by Pearson＇ s correlation coefficients. Receiver operating characteristic curves （ROCs） were generated to as- sess efficient of K tprnas in evaluation of therapeutic response. Results After treatment, mean values of clinical indicators decreased significantly [CRP： （62.68 ±31.86） vs. （43.55 ±29.63） mg/L, P =0.008; HBI： （7.18 ±2.10） vs. （5.73 ±2.33）, P = 0. 012 ]. K ,-ans showed prominent differences before and after treatment ： （ 1. g6 ± 0. 87 ） vs. （ 1.39 ±0.83） min-I , P = 0. 017. There were significant correlations between CRP or HBI and percent change of CDE-MRI parameter （ K trans ）. K trans performed well in assessment of therapeutic response with an area under the ROCs （ AUC ） of 0. 906. Conclusion K trans derived from DCE-MRI has the potential to indicate therapeutic response after FMT treatment for CD.