双源CT双能量定量参数评价结肠克罗恩病活动度的可行性研究

Feasibility study of dual-source CT dual-energy quantitative parameters evaluation of colon Crohn's disease activity

目的:探讨双源CT双能量定量参数评价克罗恩病(Crohn’s disease,CD)活动度的可行性。方法:收集38例经临床表现、内镜、影像学和组织病理学综合诊断的CD患者,行CT小肠造影(CT enterography,CTE)双能量双期增强扫描。根据肠镜蒙特利尔分型定位病变肠段,病变肠段活动度采用简化CD内镜评分系统(Simple Endoscopic Score for Crohn's Disease,SESCD)将其分为轻度活动期、中度活动期和重度活动期。比较动脉期、门脉期不同活动度病变肠段CT值、碘值、标准化CT值及标准化碘浓度(NIC)的差异,根据受试者工作特性(ROC)曲线获得各定量参数的诊断效能。结果:38例病例共53个病变肠段,其中轻度7段,中度26段,重度20段。不同严重程度病变肠段动脉期、门脉期4个参数值与正常组差异有统计学意义(P<0.05),且随严重程度增加而增大。除动脉期CT值外,双期各参数诊断重度CD均有较好效能,且门脉期均优于动脉期,门脉期NIC诊断效能最高,阈值0.59 mg/mL时,敏感度、特异度分别为80%、84.8%,AUC=0.858。结论:双能CT定量参数对评估CD病变肠壁严重程度具有较大临床价值,可为临床评价CD活动度提供依据。

Objective： To investigate the feasibility of dualsource dualenergy CT quantitative evaluation of Crohn＇s dis ease activity. Methods： Thirtyeight patients with Crohn＇s disease（CD） diagnosed by clinical manifestations, endoscopy, radiol ogy and histopathology underwent CT enterography dualenergy doublephase contrastenhanced radiography. According to the colonoscopy localization of Montreal, the bowel activity of the lesion was divided into three groups according to the Simple Endoscopic Score for Crohn＇s Disease （SESCD）： mild activity, moderate activity and severe activity period. The differences of CT value, iodine value, normalized CT value and normalized iodine concentration（NIC） in intestine between different phases of arterial phase and portal venous phase were compared. According to the receiver operating characteristic （ROC） curve Diagnos tic efficiency. Results： There were 53 lesions in 38 cases, including 7 segments of mild, 26 of moderate and 20 of severe. There were significant differences among the four parameters in the stages of intestine arterial phase and portal venous phase in different severity of disease and normal group（P〈0.05）, and increased with the increase of the severity. Except for the arte rial phase CT value, the doublephase diagnosis of severe CD parameters are better performance, and portal phase were better than the arterial phase, portal phase NIC diagnostic efficacy of the highest threshold 0.59 mg/mL, sensitivity, specificity re spectively, 80%, 84.8%, AUC=0.858. Conclusion： Quantitative parameters of dualenergy CT have great clinical value in assessing the severity of CD wall in CD patients, which can provide a basis for clinical diagnosis of CD activity.