磁共振小肠成像对英夫利昔单抗治疗小肠克罗恩病的疗效判断价值

Study on the role of magnetic resonance enterography in valuating infliximab therapy in small bowel Crohn’s Disease

目的:研究磁共振小肠成像(magnetic resonance enterography,MRE)对英夫利昔单抗(infliximab,IFX)治疗小肠克罗恩病(Crohn’s Disease,CD)疗效判断的价值。方法:IFX诱导缓解治疗27例活动期小肠CD患者,治疗前后进行MRE扫描,分析扫描各时相小肠病变在治疗前后的影像学变化特点,并与CD活动指数变化进行相关性分析。结果:(1)IFX治疗明显降低患者的克罗恩病活动指数(P<0.05);(2)小肠CD的MRE表现为肠壁多发节段性增厚强化,梳状征、肠腔狭窄或扩张,IFX治疗后肠壁厚度减少,强化减弱,梳状征消失,肠腔狭窄或扩张减轻;(3)治疗前MRE病灶信号特征为动脉期高信号或等信号,治疗转变为等信号或低信号(P<0.05),治疗后静脉期信号仍为低信号或等信号(P>0.05);(4)IFX治疗后,MRE表现改善与临床积分改善无显著差异(P>0.05)。结论:MRE对IFX治疗活动期小肠克罗恩病疗效判断具有较好价值。

Objective: Investigate the role of magnetic resonance enterography (MRE) in valuating infliximab’s (IFX) curative effect in active small bowel Crohn’s Disease (CD). Methods: 27 patients diagnosed as active CD were treated with IFX. Before and after the treatment, the patients were scanned with 3.0 T MRE after small intestinal preparation. The imaging characteristic was analyzed and the relevance analysis between the imaging performance and the clinical score were investigated. Results: 1. IFX treatment remarkably decreased the patients’ Crohn’s Disease Active Index (CDAI), P <0.05;2. In the patients with small bowel CD, MRE clearly detected the intestinal wall multiple segmental thickening and abnormal enhancement, comb sign, and intestinal stricture or dilation, which were obviously improved after IFX treatment;3. During artery phase, the signal of the intestinal lesion was improved from high signal or equal signal before the IFX treatment to equal signal or low signal after treatment ( P <0.05). During vein phase, there was no significant change of lesion signal before and after treatment (P>0.05);4. The number of MRE improvement was in accordance with that of the clinical score (P>0.05). Conclusions: MRE possesses clinical value in evaluating the IFX curative effect in active small bowel CD.